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Assessment of buried roots/ teeth |
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From radiographs assess: ¨ Natural line of withdrawal: The line along which the tooth will move when elevated. This is determined by the curvature of the roots
¨ Obstacles of elevation: They may occur along its line of withdrawal (i.e. extrinsic) or be due to the shape of the tooth (i.e. intrinsic) Extrinsic obstacles—bone, adjacent teeth or vital structures (IDN) Intrinsic obstacles— hooked or bulbous apices, adverse root curvature, constriction of tooth at cervical margin
¨ Point of Application of Elevator: Decide at planning stage where elevator will be applied i.e. to elevate root along line of withdrawal
¨ Bone removal: Only after the above factors have been considered can the amount of bone removal be calculated
¨ Flap design: The size and shape of the flap depends on the extent of the operation, and must provide access without subjecting the soft tissues to tension or trauma. Inadequate access (poor flap design; insufficient bone removal) is the commonest cause of difficulty in the extraction of unerupted teeth
When planning the removal of unerupted teeth, start in the reverse order to that in which the operation will be performed, as obviously the size and shape of the flap depends on bone removal and this in turn is related to the position of the tooth and the manoeuvres required to disimpact it.
Careful clinical examination and radiographic imaging (DPT ideal) is required. Look at: 1. Angulation—vertical, horizontal, mesio-angular, disto-angular or transverse 2. Depth of impaction from the alveolar crest to the maximum diameter of the crown 3. Degree of impaction 4. Root shape 5. Bone density 6. Relationship to ID canal 7. Presence of any other pathology
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