Extracting Root Tips

This video explains how to extract root tips and when it is appropriate to leave them alone.

Fractured Roots

• If a tooth's root fractures during extraction, irrigate the socket and apply suction before attempting to remove the fragment.

• Inspect the socket and extracted tooth to determine if the root piece was removed.

Extraction Techniques

Double Angled Root Tip Elevators

• Use double angled root tip elevators for maxillary and mandibular extractions.

• Place narrow angled elevator between alveolar bone and root tip, then push forward as epically as possible.

• Luxate the root tip until it moves, then remove it with ease.

Root Tip Pick

• Insert into periodontal ligament space and gently tease out of socket. Do not use excessive force or lateral pressure.

Interradicular Bone Removal

• Remove part of interradicular bone from inside socket with round bur or sharp instrument before extracting maxillary or mandibular molar roots.

Endodontic File

• Place file inside socket and screw into canal to deliver root tip by hand or needle holder while protecting occlusal surface with gauze.

Surgical Techniques

Soft Tissue Flap Technique

• Reflect soft tissue flap with periosteal elevator, expose buccal surface of tooth by removing bone with bur, then deliver root through opening using small straight elevator. Irrigate wound and reposition flap after suturing.

L-Shaped Incision Technique

• Make L-shaped incision, reflect flap, create small window with round bur corresponding to tip of fractured root, then enlarge window and place narrow angled elevator to displace root from socket. Remove root through window if it is small enough. Irrigate socket and suture flap after removal.

Techniques for Luxating Teeth

This section covers the techniques used to luxate teeth, including creating a groove on the surface of the root and using an elevator to engage the blade in the groove.

Creating a Groove on the Surface of the Root

• A small amount of buccal bone is removed until part of the root is exposed.

• A groove is created on the surface of the root, which serves as a purchase point for the elevator.

• This technique is mostly used in mandibles because buccal bone there is dense and can withstand applied pressure.

Creating a Groove in Bone

• In posterior mandibular teeth, where buccal bone is very dense and hard, a groove can be created in bone.

• The round bar is used between bone and root to create enough room so that we can place an elevator here.

Luxating Roots Upwards

• The blade of T-shaped or Selden elevator is seated in the groove.

• The root is luxated upwards using external oblique ridge as fulcrum.

Complications with Luxation Techniques

This section covers complications that may arise when using luxation techniques, particularly when dealing with posterior maxillary area.

Risk of Root Piece Going into Maxillary Sinus

• There's a risk of root piece going into maxillary sinus when trying to luxate it outwards from posterior maxillary area.

• To prevent this complication, radiographs should be checked carefully before extraction to assess closeness of root tips to maxillary sinus.

Displaced Root Piece into Maxillary Sinus

• If root piece gets displaced into maxillary sinus during extraction, patient should be informed about situation and new appointment scheduled.

• Removal of root tip and closure of oroantral communication are done in the same session.

• To close communication, a trapezoidal flap is lengthened by making a horizontal incision on the periosteum at the middle and base of the flap.

Situations When Leaving a Root Tip May Be Considered

This section covers situations when leaving a root tip may be considered, including when the root fragment is small, deeply embedded in bone, and not infected.

Conditions for Leaving a Root Piece Behind

• The root fragment should be small (usually no more than 4 to 5 millimeters in length).

• The root must be deeply embedded in bone and not superficial.

• The tooth involved must not be infected and there should be no radiolucency around the root apex.

High Risk of Surgery

• The risk is considered to be greater if removal of the root will cause excessive destruction of surrounding tissue or if removal might cause trauma to important structures.

• If attempting to remove the root tip might displace it into tissue spaces or into maxillary sinus, then risk of removal is greater than benefits of removal.

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