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Ia t rogenic fra cture of ma ndible,

due to Improper E leva tor Technique.J aga dish S Hiregoudar 1

ABSTRACT:

Dental extraction are one of the most common procedures in

dentistry, in particular oral surgery and may lead to various

complication including hard tissue injuries.1,2

Of the many Iatrogenic intra operative complication that, can

be caused to t he pat ient during t he procedure of tooth extraction,

the one leading to th e fracture of man dible is presented.

The purpose of this presenta tion is to ma ke the D enta l Surgeon

aware & to exercise caution in the use of Winter's cross bar

elevator, which may lead to this disastrous complication.

Key words: Ia trogenic, Exodontia , int ra operat ive complica tion,

fracture of mand ible, Winter's cross ba r elevat or.

C A S E R E P O R T

doi: 10.5866/4.4.995

1Pr incipal, P rofessor & HOD

Depart ment of Ora l & Maxillofacial S urgery

Bh abha College of Denta l Sciences,

J at khedi , Bhopal (M.P.)

Article Info:

Received: J uly 14, 2012;

Review Completed: August 14, 2012;Accepted: September 12, 2012

Availa ble Online: J an ua ry, 2013 (ww w.na cd.in)

NAD, 2012 - All righ ts reserved

Email for correspondence:

jrrk1957@gmail.com

Quick Response Code

INTRODUCTION :-

The first dictum of medicine and sur gery is Pr imum Non Cura rum first do no Ha rm 3

Injuries to the patient by the operator can be caused unknowledgeable or due to sheer negligence, in

both the instances, the patient suffers.

Certa in principals govern the use of surgical instrument s a nd th ey must be str ictly a dhered to. This casereport describes injudicious use of elevator, during the course of tooth extraction, leading to fracture of

mandible .

Case Report :-

A 35 year old female patient, w a s referred 2 day s a fter a failed at tempt of extra ction of a grossly distructed

due to Denta l ca ries, lower right 2nd ma ndibular m ola r, wit h a dditional complica tion of fractur e of the body

of ma ndible in tha t r egion.

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Indian J Dent Adv 2012; 4(4): 995-997

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Examination of the pat ient raveled abnormal

mobility in the region of 47, wit h gingiva l lacera tion

a nd clot in rela tion t o the socket of 47.

The patient had Severe pain and edema.

A periapica l ra diogra ph of the region a long w ith

a oblique la tera l ra diogra ph of the right side of the

m an d i b l e w as t ak e n , w h i ch co r re l a t e d w i t h t h e

clinical f inding of , fracture of mandible body with

the presence of the mesial root of 47, fractured a

few millimeter below the a lveola r ma rgin.

A fra cture line extending from dista l a spect of

the mesial root apex to the inferior border of the

mandible was evident

The referring D enta l Surgeon confided tha t t he

misha p ha d occurred during t he course of extra ction

of the mesial root , using the Winter s cross bar

elevator.

The case wa s ma na ged under cover of a nt ibiotics

by extraction of the retained mesial root, followed

by reduction & fixation of the ma ndibular fra cture,

wh ich hea led uneventfully.

DISCUSSION :-

Fra cture of ma ndible during routine extra ction

is fo r tunate ly , a rare compl ica t ion and i s under

reported. The reasons for this are multifactorial ,

fault y surgical technique is one am ong them.4,5,6

E l e v a t o r s , a l s o k n o w n a s e x o l e v e r s a r e

i n s t r u m e n t s w h i c h m a k e u p t h e b a s i c

armamentarium for the procedure of exodontia ,7

hence the operator must be wel l versed with the

rules governing their use.

The Wint ers crossbar or T ba r ha ndle elevat ors

(figure2) are designed for the removal of fractured

m an d i b u l a r m o l a r ro o t s . Th e y a re n e ve r u se d

elsewhere other then for elevating of mandibular

and ma xil lar y 3rd mola r impact ions.This instr ument

can develop tremendous force which can lead to

fra cture of ma ndible.

B a sed on th e wheel and a xle principal, which is

a modified form of the lever principal, the effort is

a pplied to the circumference of a wh eel w hich turn st h e ax l e so a s t o r a i se a w e i g h t , t h e g r a t e r t h e

diameter of the wheel the more is the mechanical

advantage. Hence each pound of pressure applied

to the h a ndle of the crossbar eleva tor is multiplied

on an a verage 4 to 5 times depending upon the ra dius

of the w heel, divided by t he ra dius the a xle.8

The tria ngula r sha pe Winters cross bar eleva tor

is used wh en a broken root fragment r emains in th e

ma ndibular t ooth socket a nd th e adjacent socket is

empty , devoid of root. The elevat or is placed in t he

empty socke t , w i th the t r i angular t ip f ac ing the

retained root to be removed. The shank and the

ha ndle are loca ted th e buccal side, the interradicular

septum is engaged nea r t he a pex of the socket, ca re

ta ken tha t t he point of the eleva tor does not invade

the ma ndibular cana l. A rota ry motion of the handle

will cut through and delivered the inter radicular

septum. The elevator is posi t ioned in a similar

pos i t ion , th i s t ime engag ing the f rac tured roo t

surface and a 2nd rota tory motion will delivered the

root. These paired inst rum ents a re useful to remove

fra ctured single roots eith er from th e mesia l or dista l

socket of the right or left side of the mandibular

molars .

CONCLUSION :-

I n t r a o p e r a t i v e m a n d a b u l a r f r a c t u r e a r e

considered to happen during the course of tooth

extraction as a result of improper instrumentation

and application of undue force to the bone in the

face of resistant.9

Th e r i sk o f f r ac t u re c an b e m i n i m i z e d b y

accurate assessment of the diff iculty of extraction

a n d s e l e c t i n g t h e m o s t a p p r o p r i a t e s u r g i c a l

approach.10,11

The denta l surgeon should be well aw a re of th is,

potent ia l complicat ion of wint ers cross bar elevat or

a nd exercise ca ution during t heir use.

Ia t rogenic fra cture of ma ndible J a ga dish H iregouda r

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