nbsp; In patients with advanced periodontal disease, postoperative bleeding will occur if granulation tissue is allowed to remain after removal of the affected teeth. At the time of surgery a few minutes spent removing the granulation tissue and suturing the alveolar mucosa will assure good hemorrhage control.
Infection can occur as a postoperative complication. Treatment of such infection is managed by using the principles outlined in Chapter 10.
Dry socket (localized osteitis) is one of the most perplexing postoperative complications. The etiology of the dry socket is unknown, but the following factors increase the incidence of this painful postextraction sequela: trauma, infection, decreased vascular supply of the surrounding bone, and general systemic condition.
The condition rarely occurs when minimal traumatic methods are employed during difficult or simple extractions. Meticulous debridement of all extraction wounds should be done routinely.
The etiology may be related to factors that impede or prevent adequate nourishment from reaching the newly formed blood clot within the alveolus. Patients with dense osteosclerotic bone or with teeth that have osteosclerotic alveolar walls because of chronic infection are predisposed to dry sockets.
Dry socket most commonly develops on the third or fourth postoperative day and is characterized by severe, continuous pain and necrotic odor. Clinically the condition may be described as an alveolus in which the primary blood clot has become necrotic and remains within the alveolus as a septic foreign body until it is removed by irrigation. This usually occurs a few days after extraction, leaving the alveolar walls divested of their protective covering. Severe pain, which can be controlled only by local application of potent analgesics and oral or parenteral use of analgesics or narcotics accompany the denuded bone.
To treat a septic alveolus properly, one must understand the physiology of bone repair. If the loss of the primary blood clot results from a sclerotic condition of the alveolar walls and the absence of nutrient vessels, then the resulting denuded bone surface must be viewed as any other denuded bone surface, and the dentist must rely on nature' s methods of bone repair for ultimate recovery and not employ any other methods that would disturb the healing process.
A septic alveolus is a denuded bone surface. Nature abhors denuded bone and responds to repair it. Behind this denuded and traumatized surface an immediate mechanism is set up to physiologically correct the defect. All denuded bone becomes necrotic and must be removed before it can be replaced by normal bone. During this period the contiguous region behind the alveolus is defended against invasion of pyogenic organisms within the septic alveolus, provided nothing is done to break through or violate this wall until the repair mechanism is ready to replace the nonvital structure. This process usually takes 2 to 3 weeks, depending on the regenerative capacity of the individual.
With the completion of this cycle the nonvital alveolar wall is sequestrated molecularly or enmasse and immediately behind it is a defensive and regenerative layer of juvenile connective tissue that ultimately fills the void and undergoe
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