Complications of Extractions and How to Avoid Them

Fractured root tips Roots break during extraction even when the most accomplished exodontist is at the helm. What separates the pros from the pretenders is how you handle it when it happens to you. Atomization (pulverization of roots with a bur on a high-speed handpiece), though described in some textbooks, is an imprecise and potentially dangerous way of dealing with stubborn root tips. The author has seen one case of fatal bleeding in a cat in which atomization of the palatal root of the maxillary fourth premolar was attempted. Attempts at atomization of roots of the mandible may result in dislodging of roots into the mandibular canal. When a root fractures during extraction, the first step is creation of a pedicle flap if it has not already been done. Raise gingiva and mucosa away from the buccal (aka vestibular) bone, and remove bone lateral to the root. This creates a window in the bone through which the root tip can be gently guided through. The bone lateral to the coronal portion of the root may be removed with a #1 or #2 round bur, but as the operator moves closer to the apical blood supply, a small 1⁄4 or 1⁄2 round bur is safer to avoid damage to the neurovascular bundle apical to the root. The 1⁄4 round bur may also be used to create a “moat” around the entire circumference of the root to allow room for placement of a root tip elevator on the lingual/palatal side of the root. Root tip elevators and root tip forceps are very important to have in these situations. Another trick to try to get a grasp on a persistent root is use of a small endodontic file threaded into the root canal to allow for traction in the coronal direction.