Concluded Case

Jaw Fracture

If you Fail to plan, you plan to Fail ! The jaw fracture, during or after the extraction of the lower third molar, is a rare event ! 1).It is related to poor surgical planning, inadequate handling of the tissues involved, the use of an inadequate surgical technique or the use of instruments not appropriate for the procedure, and is almost always associated with excessive use of force. 2).In most cases, the fracture has a simple line, little displacement of bone segments and is found in the jaw angle region, which is an area of low fracture resistance due to its thin section area relative to the area of the tooth and which presents the third impacted molar. What do you think ?? Suggestions are Welcome. Thank you.

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U truly said Dr. Saloni 'If u fail to plan....' henceforth before proceeding proper planning is required otherwise that will be considered under 'TRAUMATIC EXTRACTION ' so lot of factors are responsible fr that as : 1) A correct Radiographic investigation is required Eg CBCT (3D) which we cannot much appreciate in Opg ( eg Mand. Molars n it's relation to Inferior alveolar nerve) 2) Importance of anatomic considerations 3) Magnitude of impaction and Type of tooth angulation 4) length of the roots of the tooth 5) Pts. Age, whether is suffering Frm any systemic disease 6) Any Pathology associated 7) Ofcourse Skill and experience of the Doctor ( It is not mandatory a surgeon can do non traumatic extractions or A Non Surgeon can do Traumatic extractions)...
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I have seen many a times some dentists, sometimes even quite experienced ones, take lower 3rd molars lightly. Just because it is erupted, doesn't necessarily mean it will elevate easily!! Overconfidence, quackery, poor technique, wrong instrumentation, not wanting to pay the Oral Surgeon and sometimes excessive use of force (mostly due to frustration of not being able to remove it as easily as they had expected) leads to this kind of a situation. In such cases almost always we get to see a single line of fracture through the angle which again will usually be minimally displaced. Wisdom teeth, especially lowers should never be taken lightly; even the uppers. A lot of dentists take upper wisdom teeth even more lightly and end up either not being able to remove, or fracturing the buccal cortical plate or the palatal part of the tuberosity or both..!! Never take anything for granted!
Well said @Dr. Hrishikesh Bhowmick Sir, your opinion is absolutely correct, need to pay attention on this as this might be a bad case for the dentist but unforgettable and painful memory for the patient.
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Very good case for discussion I have gone through these kind of cases where an experienced doctor fracture the jaw bone but the thing is to see that why doctors do that no doctor do it intentionally but only two reasons are behind it first lack of concentration and another is lack of planing see that's why I always say that who plans never be wrong on feild so take an xary 1st see the tooth Chek the firmness of tooth by elivater and then jst as you have planed many times in my practice I have gone though some of the time takeing extractions but I always prefer to take a small break in meain while to get my concentration again for the surgery that's it if you get frustrated then remember that your pt will suffer more as you create more trauma to the pt so i always request that [its jst a tooth] it will come out the all you need is concentration....
Very relevant and aptly explained @Dr. Prashant Negi Sir, we should be pertinent enough to do such kind of procedures in order to avoid any complications further. Thanks for putting your valuable opinion sir. Appreciated.
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U truly said Dr. Saloni 'If u fail to plan....' henceforth before proceeding proper planning is required otherwise that will be considered under 'TRAUMATIC EXTRACTION ' so lot of factors are responsible fr that as : 1) A correct Radiographic investigation is required Eg CBCT (3D) which we cannot much appreciate in Opg ( eg Mand. Molars n it's relation to Inferior alveolar nerve) 2) Importance of anatomic considerations 3) Magnitude of impaction and Type of tooth angulation 4) length of the roots of the tooth 5) Pts. Age, whether is suffering Frm any systemic disease 6) Any Pathology associated 7) Ofcourse Skill and experience of the Doctor ( It is not mandatory a surgeon can do non traumatic extractions or A Non Surgeon can do Traumatic extractions)...
Very well and precisely explained @Dr. Haritma Nigam mam...thanks for putting your valuable opinion on this case. Much appreciated.
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Very significant topic raised ma'am. Fractures of jaw are the results of uncontrolled elevation forces especially for 3rd molars(impactions). Yeah we can try with elevators but with a controlled and limited force..once we get the idea that the tooth will require much greater force or will be broken by elevation, we should go for Transalveolar extraction.. I will say we should always go for Transalveolar extractions in 3rd molars especially imapaction(distoangular/mesioangular). In surgery there is no need to rely on fortune, skills and training should be reliable factors. Thanks for this case @Dr. Saloni Arora
@Dr. Ashish Tiwari you are absolutely correct,, little knowledge is dangerous thing and being a qualified doctor, every one should think about it and should not be taken on ego, humbleness to accept when we are wrong is very rare. So I think we should also be practically aware about our skills only then we should serve our society else degree is just a piece of paper when we don't know about that. Thanks for putting your opinions. Appreciated.
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Kindly show me the soft tissue picture please..otherwise ..I would like to approach intraorally ..incision in Buccoalv sulcus ..6-8mm away from gum margin for closure after procedure..use two 5whole plate and one 3whole plate. .occlusion to be done or not decision to be taken intraoperatively ..keep NPM for 1day..then start RT feed for 10days..folowd by liquid diet..for 5-7days..remove RT and then start soft diet ..and gradually normal diet..please give me feedback..
Thank you sir for your opinion, as I've only this OPG picture, and got from a close friend, who faced such type of injury way back. I just put here as it's being a rare event and unlikely case in routine but happens sometimes, just to share knowledge and learn something new, only for discussion purpose. Tht's my only motive.
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Sad to see such iatrogenic incidences , that too a fracture at the angle of the mandible , into two pieces . This one might have caused due to over pressure exerted by the dentist while he was trying elevate the tooth or so . Any way this has to screwed and plated I don’t think their is any other option left . That too under GA with a good oral and Maxillofacial surgeon approximating the fragments along with interdental wiring you keep up to the normal occlusion .
Absolutely @Dr. Nikhil S Rajan Sir, thanks for putting your valuable opinion on this case. Regards
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The dentist is going to have a bad day if this happens... very good picture, after the fracture the removal of the tooth or its fragments becomes utmost importance because it's now in the line of fire and could be a source of infection, as Dr. Saloni has rightly said planning and self assessment is very important.
Absolutely Sir.... totally agreed on your point.
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Treatment for a jaw fracture or break might also require surgery, depending on the extent of the injury. Clean breaks may heal on their own while your jaw is immobilized. Multiple fractures of the jawbone or displaced breaks in the part of the bone that's pushed off to one side may require surgical repair.
Although rare Inadvertent fracture is sometimes inevitable it mainly relys on site, angulation of tooth, preexisting bone lesions or diseases associated with bone metabolism,surgical technique. A thorough pre-operative examination should be conducted to prevent such mishaps.
Absolutely @Dr. Kausar Yadwad ,, agreed on your valuable opinion.
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You are absolutely right dr Saloni Arora I appreciate your observation My wife is suffered of this event some 45 yrs ago . #mandible while extracting last lower molar by poor planing of dentist Oh god i just recollect the difficulties she faced.
Thanks for appreciating @Dr. Shivraj Agarwal Sir actually this is unlikely case but due to quackery and little knowledge we can expect such things happening around.
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