REVIEW ARTICLE Considerations of maxillary tuberosity fractures during extraction of upper molars: a literature review Occasionally, during the course of maxillary molar extraction, the maxillary tuberosity may be fractured and may seem to be loosening when grasped by the forceps. The operator is then confronted with the problem of whether or not to proceed with the extrac- tion (1). The incidence of tuberosity fracture during upper molar extraction is relatively low. In a study conducted to investigate and compare the prevalence of complica- tions of 8455 simple tooth extractions, 0.15% of the complications proved to be tuberosity fractures (2). In a retrospective study conducted to analyze pre- and postoperative complications associated with third molar extraction, the most frequent complications included the tuberosity fracture and the bucco-sinus communication within the maxilla (3), as compared to only 0.08% of tuberosity fracture in similar study (4). Fracture of the alveolar process can be seen during tooth extractions. These fractures occur most often in the anterior or premolar regions of jaws in youth and adults (5). When the maxillary sinus is enlarged between the roots of upper molars and the maxillary tuberosity, these types of fractures can be seen during upper molar extraction. Such a complication may lead to oroantral fistula (6) or serious infection, which may result in maxillary necrosis or deafness (7). The extraction of a tooth requires that the surround- ing alveolar bone be expanded to allow an unimpeded pathway for tooth removal. However, in general, the small bone parts are removed with the tooth rather than being expanded (1, 8, 9). Fracture of a large portion of the bone in the maxillary tuberosity area is a situation of special concern. Maxillary tuberosity is especially impor- tant for the stability of maxillary dentures (8). Large fractures of the maxillary tuberosity should be viewed as severe complications. The major therapeutic goal of management is to salvage the fractured bone by main- taining it in place and to provide the best possible environment for healing. The aim of this paper is to enumerate the predispos- ing and etiological factors of maxillary tuberosity fractures during upper molar extractions, suggest appro- priate recommendations, and discuss the procedures that need to be taken when small or large fractured fragments of the tuberosity become evident during surgery. Dental Traumatology 2011; 27: 393–398; doi: 10.1111/j.1600-9657.2011.01012.x Ó 2011 John Wiley & Sons A/S 393 Bruno Ramos Chrcanovic, Belini Freire-Maia Department of Oral and Maxillofacial Surgery, School of Dentistry, Pontifı ´cia Universidade Cato ´ lica de Minas Gerais, Belo Horizonte, Brazil Correspondence to: Bruno Ramos Chrcanovic, Av. Raja Gabaglia 1000/1209, Gutierrez, Belo Horizonte, Minas Gerais CEP 30441-070, Brazil Tel.: +55 31 32920997 Fax: +55 31 25151579 e-mail: brunochrcanovic@hotmail.com Accepted 14 April, 2011 Abstract – Background: Maxillary tuberosity fractures during molar teeth extraction commonly occur in dental practice; however, very few cases have been reported and discussed in the literature. A correct preoperative radiographic interpretation, coupled with the anatomical knowledge of the structures involved, is essential to prevent such complications. Aim: The purpose of this paper is to enumerate the predisposing and etiological factors of maxillary tuberosity fractures during the extraction of upper molars, discuss the procedures that need to be taken when small or large fractured fragments of the tuberosity are evident during surgery, and suggest appropriate recommendations. This study is based on a thorough literature review. Conclusions: Upon discovering that a maxillary tuberosity has fractured, the dentist must first halt the procedure before inadvertent laceration of the adjoining soft tissue occurs and then determine the extent of the fracture by palpating the mobile fragment. After performing the dissection of the soft tissues, immediate removal of the small fractures, including the tooth with small bony fragments, may be the best option, because of the difficulty incurred when attempting to retain the bone. When a large bony fragment is present, it is recommended (i) that the extraction be abandoned and surgical removal of the tooth be performed using root sectioning, (ii) that the dentist tries to detach the fractured tuberosity from the roots, or (iii) that the dentist stabilizes the mobile part(s) of the bone by means of a rigid fixation technique for 4–6 weeks and, at a future moment, attempts a surgical removal without the use of a forceps.