Retained Roots Flashcards
Why do we see retained roots?
- Gross caries
- Trauma
- Coronectomy
- Attempted extraction (failure)
- Coronal fracture
Why do teeth fracture?
- Thick cortical bone
- Root shape- curves, Hypercementosis
- Root number
- Ankylosis (associated with trauma)
- Caries- if it is at ACJ it can be difficult
- Previous RCT- posts near furcation area of molars
- Alignment- dilacerations
- Lack of tooth tissue
** take pre-op radiographs
What mat you consider if you see a tooth with thick bulbous roots?
Splitting roots
Surgical extraction
What are the aspects of examination that we would carry out prior to extracting a tooth?
History
- Trauma
- Age
- Size
- LA experience
- Anxiety
Clinical assessment
- Infection- sinuses
- Bone loss- BPE probe
- Look at important structures near by
Radiographs
- OPT to look for adjacent anatomical structures
What are the options when there is an issue with extraction?
Leave and monitor
Progress to surgical
Refer
What are the ADV of leaving retained roots?
Preserve bone for implants
Protect nearby anatomical structures
How may you explain minor oral surgery to a patient?
- Pressure no pain
- Lift the gum (risk of nerve damage)
- Possible drilling- like fillings
- Stitches
Warn about adjacent teeth
What are the risk factors for dry socket?
Smoking
OCP use
Woman
Poor OH
Prev dry socket
Mandible
Molar tooth
How can a Victoria curette be identified?
Angled shank (looks like a V)
What are the principles of taking a flap?
- Big flap heals as well as small one- maximal access with minimal trauma
- Wide base incisions
- Aim for healing by primary intention (minimises scarring)
- Cut flap down to bone- one continuous stroke
- Be aware of adjacent anatomical structures
- Keep papilla intact
- No sharp angles
- No crushing
- Keep tissue moist
- Flap margins lie on sound bone
- Don’t close wounds under tension (affects blood supply)
What are the ADV and DIS of one sided flap?
ADV
-> long
-> good for superficial access
DIS
-> Incorporates more papillae- will need to be replaced and sutured
What are the ADV/DIS of 2 sided flap?
ADV
-> Better access
DIS
-> Can be difficult to suture relieving incision
What are the ADV/DIS of 3 sided flap
ADV
-> Excellent access
DIS
-> Difficult to suture both relieving incisions
-> Must be careful with nearby anatomical structures
What are the aims of suturing?
- Approximate tissues, compress blood vessels
- Reposition tissues
- Cover bone
- Prevent wound breakdown
- Achieve haemostasis
- Encourage healing by primary intention
What are the peri and post-op means of hameostasis?
Peri
- LA
- Artery forceps
- Diathermy
- Bone wax
Post-op
- Pressure
- LA
- Diathermy
- Surgicel- oxidised cellulose
- Sutures
What are the typical post op instructions?
- Pain
- Swelling
- Bruising
- Jaw Stiffness
- Bleeding
- Dry socket
- Damage to adjacent tooth/restoration
- Infection (unusual)
What would considerations would be required for a patient requiring extraction who has a prosthetic heart valve?
- Anti-coagulated
- Risk of endocarditis- infection of lining of heart (due to bacteraemia)
- Liaise with GP/cardiologist about ABP- delay extraction until you have spoken to someone about extraction
- Factor in an hour for prophylaxis- sit in waiting room so they can be assessed
- NICE/SDCEP guidelines- look at invasive/non procedures
What are some of the risk factors for IE?
Previous episodes
Syndromes
Invasive procedures
