Root fragment in mandibular canal

RE: Root fragment in mandibular canal

Rachel Perry — Thu, 23 May 2024 13:56:25 GMT

I would create a mucogingival flap- as if extracting it. Probably a triangular design with mesial vertical release and extending the horizontal incision caudal enough to get good access to bone overlying sockets. When raising flap obviously raise mucosa as well to give yourself plenty of access to alveolar bone . As you’ve localised root position with a radiograph I’d then remove some buccal alveolar bone and then try to remove that bone between the roots. I’ve used a periodontal probe to carefully probe in the canal once I broach it to locate the root then try to tease it out dorsally then fine root tip forceps to grasp it. Good illumination helps and suction as there’ll be a lot of blood .
changes are hard to quantify on a repeat radiograph as it’s now sitting in a canal which will look lucent around the root. So look for any changes within the root itself to suggest there might be inflammation, I’d probably do this in 3-6 months if possible.

RE: Root fragment in mandibular canal

Stigen — Thu, 23 May 2024 07:54:02 GMT

Thank you Rachel for a great answer. Costs are an issue with this patient, so don`t think they would agree to refferals. how is the procedure for entering the mandibular canal and retrievieng it myself if I choose to do another surgery, Is it just to removed the inter-radicular bone in the area and enter into the canal to look for it? there will be quite a hole there, would you use a filler, or just suture the gum directly over it? I never had this happen before. The roots were left from a previously broken tooth, I opened the gum line and extracted closed, but in hindsight would have preffered open, cause even with careful luxation the one root seemed almost ankylosed as it was not budging. Client has been informed that there is an issue, and It will come for a checkup in a few days. What kind of change are you reffering to ?

RE: Root fragment in mandibular canal

Rachel Perry — Wed, 22 May 2024 11:30:05 GMT

*inferior alveolar nerve”* my phone is taking predictive text to a new level

RE: Root fragment in mandibular canal

Rachel Perry — Wed, 22 May 2024 10:31:43 GMT

Hi Stigen, it’s hard when this happens but I’m sure it’s happened to most of us at some point. Anticipate high levels of pain as the root tip is adjacent to the inferior al solar nerve. I’d offer referral to someone to retrieve it soon if that’s possible, otherwise monitoring is going to be needed- but radiographs are difficult to tell if things change which would require removal at a later date. Obviously Inform client and document in clinical records.
If you can remove at the time it happens it’s better but I appreciate your predicament. In this case I’d remove the inter-radicular bone to create dorsal access, ideally with a piezosurgical unit which is atraumatic to soft tissues ie neurovascular bundle.
in order to prevent in future try to have great visualisation, create a small ‘moat’ around periodontal ligament space around root tip using a root tip bur then use a very fine, sharp luxator to try to tease the root out. Any pressure on top of the root itself can cause displacement.
Thank you for sharing .

did you use an open approach for these by the way or did you extract them closed?