Configuration of Roots
Radiographic assessment of the tooth to be extracted probably contributes most to the determination of difficulty of the extraction. The first factor to evaluate is the number of foots on the tooth to be extracted. Most teeth have the typical number of roots, in which case the surgical plan can be carried out in the usual fashion, but many teeth do have an abnormal number of roots. If the number of roots is known before the tooth is extracted, an alteration in the plan can be made to prevent fracture
of the additional roots (Fig. 7-9).
The surgeon must know both the curvature of the roots and the degree of root divergence to plan the. extraction procedure. Roots of the usual number and of average size may still diverge substantially and thus make the total root width so wide that it prevents extraction with normal forceps. In situations of excess curvature with wide divergence, surgical extraction may be required Fig. 7-10).
The shape of the individual root must be taken into consideration. Roots may have short; conic shapes that make them very easy to remove. However, long roots with severe and abrupt curves or hooks at their apical end are more difficult to remove. The surgeon must have . knowledge of the roots’ shapes’ before surgery to allow an adequate plan to be made (Fig. 7-11).
The size of the root must be assessed. Teeth with short roots are easier to remove than teeth with long roots. A .long root that is bulbous as a result of hypercementosis is even more difficult to remove. The periapical radiographs of older patients should be examine.d carefully for evidence of hypercementosis, because this process seems to be a result of aging (Fig. 7-12).
The surgeon should look for evidence of caries extending into the roots. Root caries may substantially weaken the root and make it more liable to fracture when the force of the forceps is applied (Fig: 7-13).
Root resorption, either internal or external, should be assessed on examination. of the radiograph. Like root. caries, root resorption weakens the root structure and renders it more likely to be fractured. Surgical extraction may be considered in situations of extensive root resorption (Fig. 7-14).
The tooth should be evaluated for previous endodontic therapy. If there was endodontic therapy many years before the extraction process, there may be ankylosis or the tooth root may be more brittle. In both of these situations, surgical extraction may be indicated (Fig. 7-15).