| Exodontia.Info |
| Fracture / Failure of Instrument with Retention of Instrument Fragment within Bone / Soft Tissue |
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Any broken instrument should be removed at the time of
the operation. If not retrievable, the patient should be told
and this recorded in the notes.
Suture needles, hypodermic needles and surgical burrs are
the items that most frequently fracture / fail in use. Suture
needles are probably the commonest items to be broken
during minor oral surgery.
the operation. If not retrievable, the patient should be told
and this recorded in the notes.
Suture needles, hypodermic needles and surgical burrs are
the items that most frequently fracture / fail in use. Suture
needles are probably the commonest items to be broken
during minor oral surgery.
As a general rule, all fragments of broken instruments
should be removed immediately before they have time to
migrate deeper into the tissues.
If the fragment cannot be found, radiographs in 2 planes at
90° should be taken of the operative area to locate it. At
this point, a decision will need to be taken as to whether to
remove the fragment or leave it in situ depending on its size
and site.
should be removed immediately before they have time to
migrate deeper into the tissues.
If the fragment cannot be found, radiographs in 2 planes at
90° should be taken of the operative area to locate it. At
this point, a decision will need to be taken as to whether to
remove the fragment or leave it in situ depending on its size
and site.
| Broken fissure bur (arrowed) in tissues which occurred during the surgical removal of an impacted lower 3rd molar |
| Broken round bur (surgical drill) and sub-periosteal dislocation of the bur which occurred during surgical extraction |
Small fragments lying sub-periostealy can be safely left as
they are unlikely to migrate and cause problems. If the
decision is taken to remove the fragment, the operative
approach will depend on where it is located and a thorough
knowledge of the local anatomy is essential if further
complications are to be avoided. It should be remembered
that small fine foreign bodies can be extremely difficult to
locate and that blind exploration of tissue spaces is wont to
displace them deeper. The use of image intensification can
be very helpful in this situation.
Breakage of an instrument in the tissues is the result of
excessive force during the removal of the tooth and usually
involves the end of the blade of various elevators or
surgical bur. Breakage may be the result of repeated use
of the instrument altering its metallic composition (mainly of
the bur). In these cases, after precise radiographic
localisation, the broken piece(s) are removed surgically at
the same time as extraction of the tooth or root.
they are unlikely to migrate and cause problems. If the
decision is taken to remove the fragment, the operative
approach will depend on where it is located and a thorough
knowledge of the local anatomy is essential if further
complications are to be avoided. It should be remembered
that small fine foreign bodies can be extremely difficult to
locate and that blind exploration of tissue spaces is wont to
displace them deeper. The use of image intensification can
be very helpful in this situation.
Breakage of an instrument in the tissues is the result of
excessive force during the removal of the tooth and usually
involves the end of the blade of various elevators or
surgical bur. Breakage may be the result of repeated use
of the instrument altering its metallic composition (mainly of
the bur). In these cases, after precise radiographic
localisation, the broken piece(s) are removed surgically at
the same time as extraction of the tooth or root.
