Simple introduction about the management and minor surgical removal of retained roots.

1. EXTRACTIO
N OF
RETAINED
ROOTS
By :Mohammed Al-Shalfi
4th faculty of Dentistry Ibb University

2. ABSTRACT :
Root tip fracture can occur during the
extraction of teeth. The clinician must then
decide to either leave the root fragment in
situ, or to attempt its removal. A similar
decision is made when retained root
fragments are found incidentally on oral
radiographs.
Retained root fragments are a common
occurrence in both dentate and edentulous
patients. Practitioners often differ in their
opinion on whether these retained roots
should be removed and their presence can
pose challenges to clinicians when
formulating a treatment plan based on an

3. RETAINED
ROOTS
• Retained root refers to the partial root structure that
remains in the jaw following the extraction or fracture of
a natural tooth. If the retained root remains it will either
stay frozen in the bone forever or work its way out where
it can be removed. Retained root however may cause
infection of the jaw or osteitis.
• Another common symptom of retained roots problem
is the presence of a bitter taste or smell emerging from
an unknown area in the mouth. The most susceptible
regions of the teeth to this problem is the wisdom tooth
areas (third molar regions) followed by the first molar
areas (six-year molar areas.)
• Retained roots are also used a way to provide support
to overdentures. Overdentures can either be a full or
partial denture which is designed to fit over retained
teeth or roots. The advantage that overdentures have
over complete destures is that the retained roots aid in
the preservation of the alveolar bone and also provides
an established pattern of mastication and height of bone
in the alveolar ridge. However in instances of severe
tooth decay the roots will have to be removed.

4. RETAINED OR FRACTURE OF
ROOT
• Fractured or Broken Root Tips
Description :
• A portion of the root is fractured and not
extracted with the rest of the tooth.
• Can be a result of improper extraction
technique, ankylosis, or spontaneously
resorbing or necrotic roots/root ends.
•Always inspect the extracted tooth root for a
smooth round apex. If there is a rough or
jagged edge to the root, there is probably still
a root remnant remaining in the alveolus.
•Always take post‐extraction radiographs to
document complete extraction of the entire
tooth and root without damage to the
surrounding bone. Sometimes, despite our
best attempts, tooth roots fracture during
oral surgery to extract the tooth and
additional surgery is needed to extract the
root tip.

5. REATAINED OR FRACTURE OF
ROOT
• Importance of Dental Radiology
• Any time it is suspected that a fragment of root has
been left behind, a radiograph should be taken. It is
better to find a piece of root at the time of extraction than
to be forced into a surgical revision.
• The practitioner should weigh the risk associated with
leaving a portion of the root in the socket against the
damage that may occur to tissue while extracting the
retained portion of root. If there is no infection at the site
and circulation to the root tip appears intact, it may be an
acceptable risk to leave the root tip in place.In such cases,
client communication is of the utmost importance so that
there is no chance for them to be exposed to a surprising
revelation at a later date.
• However, if the clinician’s assessment of this is
incorrect, a complication, resulting in sequestration and
fistulation, may occur. It is best to be conservative and
remove any root tips of questionable soundness. Clients
hate surprises and anticipate “one-stop shopping” in
cases of extraction.
• A fractured root that is left in the socket should be

6. REATAINED OR FRACTURE OF
ROOT
• Non Surgical Removal:
Normally simply pressing down beside the
root will force it to the surface, this is called
“Elevation” and will result in minimal post
extraction pain or swelling.
If the root was mobile prior to root fracture,
it is sometimes possible to elevate and
extract the remaining root tip without
removal of additional bone using small
elevators or root tip picks. In most instances
it is advantageous to remove additional
buccal bone to improve visualization and
identification of the root tip. It may be
quicker and less traumatic for the patient to
complete an open exposure for retrieval of a
fractured root tip. Adequate lighting and
magnification greatly assist in the retrieval
of fractured root tips.

7. REATAINED OR FRACTURE OF
ROOT
• What if the attempt to remove the root
tip is unsuccessful ? When can root tips
be left in place?
Root tips can be left in place only if the risks of
surgery to remove the root tip outweigh the
benefits of removing the root tip.
To leave a fractured root tip in place, the root tip
must be small, deep within the alveolus, the tooth
must not be infected, and there must be no
periapical radiolucency visible radiographically.
A root tip may not be left in place if there is any
evidence of periodontal disease or potential for
endodontic disease (complicated crown fracture,
uncomplicated crown fracture, pulp hemorrhage,
radiographic evidence of periapical pathology)
associated with the root tip.
Non infected ratained root may aid in preserving the
alveolar bone and help in treatment
with overdenture

8. REATAINED OR FRACTURE OF
ROOT
•Surgical Removal :
Although Initial attempts should be made to extract the root fragment by a closed
technique, but the surgeon should begin a surgical technique if the closed technique is
not immediately successful. Whichever technique is chosen, two requirements for
extraction are critically important: excellent light and’ excellent suction,
preferably with a suction tip of small diameter. It is impossible to remove a
small root tip fragment unless the surgeon can clearly visualize it. It is also important
that an irrigation syringe’ he available to irrigate blood and debris from around
the root tip so that it can be clearly seen.

9. SUMMARY
OF
SURGICAL
PROCEDUR
E
• From a procedural standpoint, the surgical
extraction of a residual tooth root is a
straightforward event. Your dentist will provide
local anesthetic to numb the area, or if you are
overly anxious about the
procedure, analgesia may be administered.
Then, your dentist will make an incision along
your gumline, creating what is known as a
“surgical flap.” This “flap” of tissue allows a
dentist to gain access to the bone along the
side of the jaw that is encasing the tooth root.
• Once the flap is created, your dentist would
then likely need to use a surgical hand-piece to
gently layer away the bone so as to provide
access to residual root for extraction. Once
visible, if the residual root cannot be extracted
whole, it may need to be segmented (or, cut) in
order to remove it.

10. SUMMARY
OF
SURGICAL
PROCEDUR
E
• Once segmented, your dentist will likely need to “rock”
the root back and forth to ease in its removal. This is
done either with a pair of forceps, or a dental tool known
as an “elevator,” which is akin to a common lever, and
somewhat resembles a small flat-head screwdriver. Since
the bone in our jaws is soft, this gentle rocking motion
actually compresses the bone slightly so the root can be
removed without the need to apply excessive force. Final
removal is usually done with a tug of the forceps.
• Once the tooth root has been removed, and depending
on your next steps for care, your dentist may conduct
a tooth socket graft to prevent bone resorption.
• Some pain and swelling should be expected and
you will prescripe painkillers for several days. You may
also need anantibiotics and these will be
prescribed. The procedure should normally last less
than ten minutes.
•The pain and swelling should be at their maximum the
following morning and should resolve over 7 to 10 days.
• The extraction socket must be cleaned for several days.
Rinse your mouth with Warm Salty Water after meals
and chlorhexidine digluconate Mouth Wash morning and
night for about 10 days will help.