![]() Perforation of the maxillary sinus, injury to the inferior alveolar bundle, and injury to the mental foramen are 3 common examples. One governing aspect in the clinician’s decision tree is the consideration of further danger to surrounding anatomy that would adversely impact the outcome by removing the root fragment. ![]() These complications include local inflammation, cyst formation, and pain. 3Ĭonversely, there is clear evidence that if the broken root tip is left in, communication with the oral cavity as opposed to sequestered in the bone, the incidence of complications increases. These roots undergo typical wound closure and healing. Roots are reduced 2.0 mm subosseously to preserve bone. ![]() It is worth noting that sometimes vital roots are intentionally retained for improved prosthetic outcomes. He further concluded that 83% were associated with neither symptoms nor pathology. ![]() He found that most retained roots “develop tissues that heal over them and there was a progression of root canal closure and fibrosis of the pulp.” 6 It is a concept reviewed as early as 1960 by Helsham, 6 who examined 2,000 patients referred for the removal of retained roots. In the past 11 years, there has been abundant literature weighing in on the outcome of leaving retained roots. Not doing so would lead to pain, infection, and cyst development.” 3 Leaving the root tip: Historically, there was a consensus that “all root tips should be removed. Even then, all surgeons experience root tip breakage.įigure 6. It is recommended that a Brasseler 859.36.010 bur (Brasseler USA) on a high-speed drill be employed to create the trough (Figure 3). Salvin Dental Specialties and Hu-Friedy both have wide arrays of elevators to execute these principles (Figure 2). Modernization of the elevator and root tip picks (another form of an elevator) has dramatically improved the ability of today’s clinicians to both avoid root breakage and elevate remaining root tips, if broken. When used properly, it allows biomechanical creep to occur, ultimately resulting in bone expansion. 4 The use of dental elevators to remove roots is historically an old concept. The author defines a trough as a small slot between the root and alveolus that parallels the root. Finally, create mesial and distal troughs (not buccal or palatal) and then elevate the roots with any number of the myriad of root tip elevators available. On mandibular molars, it would be the MB root from the DB root and then the MB from the ML. On maxillary molars, this would be the MB from the DB and then the palatal root. Next, it is advised to section the roots. The very act of separating the crown from the root trunk creates better vision and access of the roots. The best way to prevent root tip breakage is to execute protocols to drive forces apically. Keep in mind this important axiom: The primary cause of root tip breakage is too much force in the coronal portion of the tooth, as opposed to the apical region. The moment your patient becomes unpredictable in your chair, your clinical skills will be compromised. Anxious patients are more inclined to experience hypertensive episodes. Further, every surgical case performed would be better managed with some level of oral sedation. Maxillofacial surgery offices are better equipped to manage the range of serious medical complications that arise from treating brittle patients. Although this article is about clinical complications, recommendations would start by limiting your surgical removal to patients with a medical history that would fall under ASA I and II classification. The author would like to note that a plethora of complications could be simply avoided with rigorous patient vetting. This article will address 2 common clinical complications and their recommended solutions.
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