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The extraction of a tooth requires that the surrounding alveolar bone be expanded to allow an unimpeded pathway for tooth removal. However, in generally the small bone parts are removed with the tooth instead of expanding.1�C4 Fracture of a large portion of bone in the maxillary tuberosity area is a situation of special concern. The maxillary tuberosity is especially important for the stability of maxillary denture.
2,3 Large fractures of the maxillary tuberosity should be viewed as a grave complication. The major therapeutic goal of management is to salvage the fractured bone in place and to provide the best possible environment for healing.3 Routine treatment of the large maxillary tuberosity fractures is to stabilize the mobile part(s) of bone with one of rigid fixation techniques for 4 to 6 weeks. Following adequate healing, a surgical extraction procedure may be attempted. However, if the tooth is infected or symptomatic at the time of the tuberosity fracture, the extraction should be continued by loosening the gingival cuff and removing as little bone as possible while attempting to avoid separation of the tuberosity from the 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 sutures because there may not be a clinical oroantral communication. The surgeon may elect to graft the area after 4 to 6 weeks of healing and postoperative antibiotic therapy. If the tooth is symptomatic but there is no frank sign of purulence or infection, the surgeon may elect to attempt to use the attached bone as an autogenous graft.5 There are many reports about complication of the tooth extraction in the literature, but only a few cases are about maxillary tuberosity fractures. The purpose of this paper is to present a case of maxillary tuberosity large fracture during extraction of first maxillary molar tooth, because of high possibility in dental practice but being rare in literature.
CASE REPORT A 28-year-old Caucasian male was referred to our clinic by the patient��s general dental practitioner (GDP) after the practitioner attempted to extract the patient��s upper right first molar tooth with forceps. He was a healthy young man with no history of significant medical problems. In dental examination; the maxillary right first, second and third Brefeldin_A molars were elevated and mobile, so the patient was unable to close his mouth (Figure 1). An oroantral communication and bleeding from right nostril were present.