Retained Roots

Question 1

Why do we see retained roots?

Answer 1

Gross caries
Trauma
Coronectomy M3M
Attempted extraction

Question 2

Why do teeth fracture?

Answer 2

Thick cortical bone
Root shape
Root number
Ankylosis
Caries
Prev RCT

Question 3

Why can we keep retained root?

Answer 3

Preserve bone height (implant placement in future)
Near vital anatomical structure

Can be left alone and monitored - only remove if carious or exposed itself through gingiva

Discuss and consent pt

Question 4

Explain surgical procedure in layman terms

Answer 4

Pressure no pain
Lift the gum up
Poss drilling (same one as filllings) - water
Stitches that go away by themselves

Question 5

Pos op complications

Answer 5

Pain
Sweling
Bleeding
Brusiing
Jaw stiffness
Dry socket
Infection
Damage to adjacent tooth/rest

Question 6

General surgical principles

Answer 6

Maximal access with minimal trauma
* Bigger flaps heal just as quickly as
smaller ones
* Wide-based incision - circulation
* Use scalpel in one firm continuous stroke
* No sharp angles
* Adequate sized flap
* Minimise trauma to dental papillae
* Flap reflection should be down to bone and
done cleanly
* No crushing
* Keep tissue moist
* Ensure that flap margins and sutures will lie
on sound bone
* Make sure wounds are not closed under
tension
* Aim for healing by primary intention to
minimise scarring

Question 7

Describe soft tissue retraction

Answer 7

Howarths periosteal elevator
rake retractor
Minnesota retractor

No sharp edges
Wider and less traumatic
Round, smooth end placed on bone

Question 8

Debridement

Answer 8

Physical
- Bone file or handpiece to remove sharp bony edges
- Mitchells trimmers or Victoria curette to remove soft tissue debris

Irrigation
- Sterile saline/water into socket and under flap

Suction
- Aspirate under flap to remove debris
- Check socket for retained apices etc

Question 9

Suturing

Answer 9

Approximate tissue
Compress BV

Aims
- repos tissues
- Cover bone
- prevent wound breakdown
- Achieve haemostasis
- Encourage healing by primary intention

Question 10

Peri op Haemostasis

Answer 10

La with vasocosntrictor
Artery forceps
Diathermy
Bone wax

Question 11

Post op Haemostasis

Answer 11

Pressure
LA vasoconstrictor
Diathermy
Surgicel
Sutures