Abstract
We describe a new technique for the removal of broken tooth roots utilizing existing dental equipment.
Introduction
Tooth extraction occasionally results in the fracture of roots. Removal of the roots is often attempted using forceps and/or elevators and, should that fail, clinicians are required to surgically raise a flap, retract soft tissues and drill into the bone abutting the tooth root. This is effective but it requires surgical skills. If the dentist is not confident or is not trained to surgically remove teeth, referral to a specialist is required. This is problematic in remote locations. In addition, the retention of broken roots could result in infection or failure to relieve the pain.
Description
We recommend a new technique that utilizes existing dental equipment, i.e. a motor-driven dental hand piece and a large surgical burr. The dentist drills vertically into the root which is in direct contrast to the conventional surgical method where the dentist drills into the bone adjacent to the tooth (Figure 1). With this method the tooth structure is cut out and a slight amount of bone may be cut by the burr to ensure that a ‘shell’ of tooth does not remain. This enables the healing of the bony extraction socket. The key differences from the conventional ‘open’ method of surgical extraction are: muco-gingiva flaps are not required to be raised; tooth – and not bone – is cut with a burr and, hence, there is minimal risk of thermal osteonecrosis; saline irrigation to cool the burr is recommended but not essential; and the bone buccal of the tooth is not damaged by the burr.
(a) The intact tooth that requires removal; (b) root fracture during extraction with apical terminal portion retained; (c) large surgical burr used to grind out the tooth from bone and (d) root extracted without soft tissue incisions and minimal bone cutting.
Conclusion
The advantages of our technique are: easy removal of broken roots is made possible so that the focus of the infection can be removed; no soft tissue incisions or flap reflection are required; there is no thermal necrosis of bone since burr cuts tooth; root removal can be performed without the help of an assistant; and the bone buccal to the tooth is not cut by the burr, which is crucial if the patient requires dental implants. The procedural differences between our method and conventional surgical extraction result in less inflammation and, consequently, less swelling and discomfort after broken roots are removed.
Footnotes
Declaration of conflicting interests
None declared.
Funding
This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.