Retained Roots

Question 1

Why do we see retained roots?

Answer 1

• Gross caries
• Trauma
• Coronectomy
• Attempted extraction (failure)
• Coronal fracture

Question 2

Why do teeth fracture?

Answer 2

• 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

Question 3

What mat you consider if you see a tooth with thick bulbous roots?

Answer 3

Splitting roots

Surgical extraction

Question 4

What are the aspects of examination that we would carry out prior to extracting a tooth?

Answer 4

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

Question 5

What are the options when there is an issue with extraction?

Answer 5

Leave and monitor

Progress to surgical

Refer

Question 6

What are the ADV of leaving retained roots?

Answer 6

Preserve bone for implants

Protect nearby anatomical structures

Question 7

How may you explain minor oral surgery to a patient?

Answer 7

• Pressure no pain
• Lift the gum (risk of nerve damage)
• Possible drilling- like fillings
• Stitches
  Warn about adjacent teeth

Question 8

What are the risk factors for dry socket?

Answer 8

Smoking

OCP use

Woman

Poor OH

Prev dry socket

Mandible

Molar tooth

Question 9

How can a Victoria curette be identified?

Answer 9

Angled shank (looks like a V)

Question 10

What are the principles of taking a flap?

Answer 10

• 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)

Question 11

What are the ADV and DIS of one sided flap?

Answer 11

ADV
-> long
-> good for superficial access

DIS
-> Incorporates more papillae- will need to be replaced and sutured

Question 12

What are the ADV/DIS of 2 sided flap?

Answer 12

ADV
-> Better access

DIS
-> Can be difficult to suture relieving incision

Question 13

What are the ADV/DIS of 3 sided flap

Answer 13

ADV
-> Excellent access

DIS
-> Difficult to suture both relieving incisions
-> Must be careful with nearby anatomical structures

Question 14

What are the aims of suturing?

Answer 14

• Approximate tissues, compress blood vessels
• Reposition tissues
• Cover bone
• Prevent wound breakdown
• Achieve haemostasis
• Encourage healing by primary intention

Question 15

What are the peri and post-op means of hameostasis?

Answer 15

Peri
- LA
- Artery forceps
- Diathermy
- Bone wax
Post-op
- Pressure
- LA
- Diathermy
- Surgicel- oxidised cellulose
- Sutures

Question 16

What are the typical post op instructions?

Answer 16

• Pain
• Swelling
• Bruising
• Jaw Stiffness
• Bleeding
• Dry socket
• Damage to adjacent tooth/restoration
• Infection (unusual)

Question 17

What would considerations would be required for a patient requiring extraction who has a prosthetic heart valve?

Answer 17

• 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

Question 18

What are some of the risk factors for IE?

Answer 18

Previous episodes

Syndromes

Invasive procedures