Complicated tooth extraction

. He presented a swelling just beneath the left eye. The owners suspected a tumor, considering the size of the swelling and the age of the patient.

However at a closer examination of the oral cavity we discovered an old fracture with pulp exposure and pulp necrosis at the upper 4th premolar or the carnasial tooth.

The X-rays were performed at the Radiology Department for the whole head and neck area since the diagnosis o neoplasm could not have been overruled.

The typical radiolucency of the apical area for more than 1/3 of the root apex lead us to the conclusion that the swelling (Fig1) was caused by the tooth peri-apical infection.

We decided to extract the tooth by separating the 3 roots with a high-speed turbine and a round steel burr, Fig 2.

The palatal fragment was extracted without problems; however both mesial and distal roots fractured during extraction, leaving a 2-4 mm fragment of the apical root area, Fig 3.

We had to perform retro-alveolar X-rays in bisecting angle incidence in order to localize the fragments respective to the alveolar bone.

The mesial root had an apical rest in the disto-palatal area and the distal root on both sides about 4 mm of root rest, Fig 4. 

The root fractured neither due to lack of experience of the operator, nor due to technique mistake, but as it quite often happens, due to ankylosis of the roots in the alveolar socket.

This means that the roots make an common body with the alveolar bone. This issue can be solved by means of vestibular flap exposure of the broken root fragments, or by atomization of the fragments by means of a high-speed turbine.

We decided to perform atomization since it’s more expedite and less invasive than the muco-periosteal and bone flap method. The control X-rays performed prove that the fragments were removed, Fig 5.

A proper antibiotherapy was prescribed with Antirobe (Clindamycin) 150mg for 7 days post-extraction. The swelling receded in 3 days and the general condition of "Cavin” improved immediately.

DDr. Camil Stoian PhD, Mag. Helene Widmann