Failed Tooth XLA

Question 1

How do you clinically assess difficulty of tooth XLA pre-operatively?

Answer 1

Mobility, structural integrity, presence of caries, bone loss
Pt compliance

Question 2

What to assess radiographically on difficulty of tooth XLA pre-operatively?

Answer 2

Length of roots
Position floor maxillary sinus
Shape of roots
Extent of caries
Bone density
PA lucency

Question 3

Have upper 6- remove buccal root successfully, unable to remove palatal root. What is risk of attempting XLA?

Answer 3

Displacement into maxillary sinus
Creation OAC

Question 4

What should you do if you think you have displaced root into sinus?

Answer 4

Stop and ensure remaining root has been extracted
Close socket primarily to reduce OAC
Take RAD and inform pt

Question 5

How to explain that root has been displaced into sinus?

Answer 5

Inform patient a piece of the tooth has been pushed into the maxillary sinus
Explain that only requires removal if becomes symptomatic
Advised of what to do if start to feel feverish/ generally unwell/ signs spreading infection close to eye
If symptoms - referral local maxfax unit

Question 6

What procedure is used to remove objects form sinus?

Answer 6

Direct surgical approach (Caldwell-Luc) or endoscopic approach

Question 7

In what instances should you leave root remaining?

Answer 7

Pre-op tooth vitality
Lack of periodical infection
Lack of mobility during extraction