Policy for Leaving Root Fragments
When a root tip has fractured, when closed approaches of. .removal have been unsuccessful, and when. the open approach may be excessively traumatic, the surgeon may consider leaving the root in place. As with any surgical approach, the surgeon must balance the benefits of surgery against the risks of surgery. In some situations the risks of removing a small root tip may outweigh the benefits. Three conditions must exist for a tooth root to be left in the alveolar process. First, the root fragment must be small, usually no more than 4 to 5 mm in length. Second, the root must be deeply embedded in bone and riot superficial, to prevent subsequent bone esorption from posing the tooth root and interfering with the prosthesis
that will be constructed over the edentulous area. Third,·the tooth involved must not be infected, and there must be no radiolucency around the root apex. This lessens the likelihood that subsequent infections ‘Will
result from .leaving the root in position. If these three 8-49 A, conditions exist, then consideration can be given to leaving the root. For the surgeon to leave a small, deeply embedded, noninfected root tip in place, the risk of surgery must be greater than the benefit. This risk is considered to be greater if one of the following three conditions exists: First, the risk is too great if removal of the root will cause excessive destruction of surrounding tissue; that is, if excessive amounts of bony tissue must be removed to retrieve the root. For example, reaching a small palatal root tip of a maxillary first molar may require the removal of large amounts of bone.Second, the risk is too great if removal of the root ndangers vital structures, most commonly the inferioralveolar nerve, either at the mental foramen area or along the course of the canal. If surgical retrieval of a root may result in a ‘permanent or even a prolonged temporary anesthesia of the !:,fprior alveolar nerve, the surgeon should seriously consider- leaving the root tip in place. finally, the risks outweigh the benefits if attempts at recovering the root tip can displace the root into tissue spaces or into the maxillary sinus. The roots most often displaced into the maxillary sinus are those of the maxillarymolars. If the preoperative radiograph shows that the bone is thin over the roots of the teeth and that the separation between the teeth and maxillary sinus is mall, the prudent surgeon will choose to leave a small root fragment ather than risk displacing it into the maxillary sinus. Likewise, roots of the mandibular second and third molars can be displacedinto the submandibular space uring attempts to remove them. During retrieval of any root tip, apical pressure may displace teeth into tissue spaces or into the sinus. If the surgeon elects to leave a root tip in place, a strictprotocol must be observed. The patient must be informed that, in the surgeon’s judgment, leaving the root in its position will do less harm than surgery. In addition, radiographicdocumentation of the root tip’s presence and position must be obtained and retained in the patient’s record. The fact that the patient was informed of-the decision to leave the root tip in position must be recorded in the patient’s chart. In addition, the patient must be recalled for everal routine periodic follow-ups over the ensuing year t-o track the fate of this root. The patient should be instructed to contact the surgeon immediately should any problems . develop in the area of the retained root.