When an upper premolar / bicuspid (rare) or an upper molar (more likely) is
extracted, there is a risk that the bony socket comes out with the tooth. This is
often accompanied by tearing of the gum (both cheek and roof of the mouth side,
mainly the roof of the mouth side).
of special concern. The The fracture of a large portion of bone in the area is a
situation is especially important for the stability maxillary maxillary of upper
dentures and may cause a mouth-sinus comminication (oro-antral communication).
If there is a large maxillary tuberosity fracture, the aim is to salvage the fractured
bone in place and to provide the best possible environment for healing.
Routine treatment of the large maxillary tuberosity fractures is to stabilise the
mobile part(s) of bone with rigid fixation techniques (i.e. splinting with archbars or
immobilisation with a plastic splint) for 4 – 6 weeks.
Following adequate healing, a surgical extraction procedure may be attempted.
However, if the tooth is infected / symptomatic at the time of the tuberosity
fracture, the extraction should be continued by loosening the cuff of gum and
removing as little bone as possible while attempting to avoid separation of the
tuberosity from the layer of skin immediately overlying the bone (periosteum).
If the attempt to remove the attached bone is unsuccessful and the infected tooth is
delivered with the attached tuberosity, the tissues should be closed with watertight
stitches (sutures) as there may not be a clinical oro-antral communication.
The Oral Surgeon may elect to graft the area after 4 – 6 weeks of healing and post-
operative antibiotic therapy. If the tooth is symptomatic but there is no frank sign
of purulence or infection, the Oral Surgeon may elect to attempt to use the
attached bone as an autogenous graft.
The factors predisposing to a fractured maxillary tuberosity during extraction of
upper molars are:
• a large maxillary sinus with thin walls
• a tooth with large divergent roots
• a lone standing molar
• excessive force is used to remove the tooth
• an abnormal number of roots and
• dental anomalies such as tooth fusion, tooth isolation, over-eruption,
ankylosis and hypercementosis of upper molar teeth.
• a chronic apical infection of the molar (may result in bone sclerosis making a
fractured tuberosity more likely)
Not only forceps extraction of a resistant second or third molar but also first molar
may result in fracture of the maxillary tuberosity.
All Oral Surgeons who practice exodontia must be able to manage this
complication, immediately the problem occurs.
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