Exodontia.Info
Fractured Maxillary Tuberosity
The maxillary tuberosity is the most hind-most
(
distal) aspect of the upper jaw (maxilla),
housing the sockets of the upper wisdom teeth,
with its back (
posterior) border curving upward
and distally.

The upper wisdom tooth lies just in front and within the
maxillary tuberosity.
Pictures showing the location of the
Maxillary Tuberosity
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,
but mainly the roof of the mouth side).

The 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 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.
Piece of Adherent Tuberosity

"Mild / Small Tuberosity Fracture"
Extracted Upper Molars with Larger Piece of Adherent Tuberosity

"Moderate / Medium Tuberosity Fracture"
Extracted Upper Molar with Adherent Tuberosity, Pterygoid Plates, Blood Supply
& Muscles
"Severe / Catastrophic Tuberosity Fracture"
Useful Article:

British Dental Journal 2005; 198: 543–544.  An extraction complicated by lateral
and medial pterygoid tethering of a fractured maxillary tuberosity.
Last Updated 11th August 2010