Tooth root removal - technique, how to remove a tooth if only the root remains, indications

When is tooth root removal required?

The decision to remove a tooth root can only be made by the attending physician, taking into account the patient’s indications in a particular case. If the affected tooth root can be treated, then the necessary procedures can be carried out and used as a support for the crown. However, there are a number of scenarios that require mandatory root removal.

If, as a result of advanced periodontitis, the tooth has become mobile.
When the root of a tooth is broken or cracked and hurts, and the gums and cheek are swollen.
If the tooth is destroyed to the level of gum tissue and cannot be restored.
When a wisdom tooth interferes with the development and alignment of other teeth or causes constant pain.
If there is a cyst that cannot be removed without removing the root.
If the wall of the tooth breaks off, and the resulting fragment extends under the gum.
When part of the root remains after tooth extraction.

Separately, it is worth noting the removal of the root of baby teeth - usually dentists prefer to let the tooth fall out on its own, but sometimes intervention is necessary, for example, when more than half of the tooth is damaged by caries; when the tooth is very loose; if a tooth is broken and its remainder injures the gums; when the root is affected by caries and there is a risk of spreading to the adjacent tooth; with severe inflammation in the root area, which cannot be eliminated without resorting to removal.

Relieve pain before going to the doctor

For any form of periodontitis, it is necessary to make an appointment with a doctor, but often the aching tooth “does not want” to wait for the appointed time and hurts unbearably. Taking a pain reliever will help relieve the condition. For toothache, experts advise taking medications that are most optimal for such cases. The pill will not cure, but it will relieve the pain. This does not mean that you can postpone a visit to the doctor - after the pill wears off, the pain will return, so a trip to the dentist should not be postponed or put off “for later”.

Is it possible to leave it?

Some patients can walk for years with a tooth destroyed to the ground, not realizing that rotting roots are a breeding ground for infection and, at a minimum, provoke constant bad breath. Affected roots absorb bacteria and food particles like a sponge. Over time, plaque and stone form on the remnants of the root, causing the gum tissue to become inflamed.

Often patients ignore the problem, hoping that root removal without a tooth will not be necessary, since it will come out on its own. This is a big misconception - in rare cases, a fragment of a tooth can actually come out, but not its root. Delay will only lead to the root becoming overgrown, which is why the gum will have to be cut to remove the root of the destroyed tooth.

The body's constant fight against infection in the root area means that the human immune system directs part of its resources to solve the problem. Ultimately, this will provoke the development of infection and inflammation, and for patients this turns out to be a surprise every time. In some cases, if the rotten tooth root is not removed in time, infection in the upper jaw can spread to the maxillary sinuses, and in the lower jaw it can lead to a fracture or osteomyelitis.

Signs that a root remains after tooth extraction

If the root remains in the gum after a tooth extraction was performed poorly, then the problem is difficult to identify without diagnosis. But if a lot of time has passed since the extraction, and you feel twitching or pulsation in the area of the missing tooth, acute pain due to mechanical impact, observe redness or bleeding from the gums, or increased temperature, this may very likely indicate the presence of a tooth root remnant. If a root remains in the gum after tooth extraction, the consequences will not take long to arrive. Therefore, as soon as you have such a suspicion, contact a specialist as soon as possible.

What are the dangers of rotten teeth, consequences for the body

Many people ignore the process of tooth decay unless it is accompanied by severe pain. But the consequences of the carious process can be unpredictable and dangerous. If you have rotten teeth, the following complications may develop:

Destruction of bone tissue of the musculoskeletal system.
Endocarditis is inflammation of the lining of the heart.
Inflammatory pathologies of the kidneys.
Infections of ENT organs.
Psychological complexes due to discomfort during communication and dissatisfaction with the appearance of the dentition.
Purulent-inflammatory diseases in the gums (abscesses, phlegmons) and, as a result, the spread of infection throughout the body, leading to general intoxication.

The health of baby teeth greatly affects the condition of the permanent buds. Therefore, if nothing is done about the decay of milk dental tissues, in the future the child may have big problems with the formation of a permanent dentition.

Stages of removing the root of a decayed tooth

The operation of removing the root of a tooth is a procedure even more labor-intensive than removing a whole tooth. Preparation standardly includes a visual examination of the oral cavity, diagnosis using special equipment and sanitation. The test results allow you to draw up a treatment plan in accordance with medical indications, age, health status and other characteristics of the body, as well as select the optimal instruments and anesthetics for the procedure.

How is root removal done without a tooth?

The doctor injects the patient with a local anesthetic, selected in such a way as to exclude allergies and other body reactions.
After 10 minutes (when the anesthetic has taken effect), the circular ligament is separated from the neck of the tooth. If there is no inflammation of the gum tissue, then they are also moved away from the edge of the alveoli. If the root is deeply recessed into the hole or has become overgrown, then you will need to cut the gum and drill out part of the bone tissue to access the root.
Next, the tooth root is removed using forceps or a dental elevator. If the tooth has a multi-root system, it will first be separated using a drill or ultrasound, and then removed in parts. This is called complex removal.
After removing the tooth root, the hole is treated with a special solution. If the gum is cut, then after the operation sutures are placed and the operated area is treated with drugs that will help speed up healing.

Note!

Removing the root of the upper teeth is somewhat different from removing the roots of the lower jaw tooth. The roots of the lower jaw are most often removed using elevators: the instrument is placed between the gum bone tissue and the root and the handle is rotated. When removing the roots of the teeth of the upper jaw, bayonet-shaped forceps are often used - medium for canines, incisors and premolars and wide for molars. Using a tool, the circular ligament of the tooth is first peeled off, then single roots are twisted, and those connected to each other are dislocated.

Features of wisdom tooth root removal

When removing the root of wisdom teeth, the complexity of the procedure is added by the fact that figure eights often grow at an angle; accordingly, their roots are located perpendicular to the roots of neighboring teeth. Therefore, the procedure is carried out using x-rays, especially if the crown is destroyed. The procedure should be carried out by an experienced specialist to eliminate the possibility that a root remains after the removal of a wisdom tooth.

Dystropic tooth: indications for removal

A tooth with an incorrect location in the dentition relative to its neighbors is called dystrophic. It can take the place of another, spontaneously turn, change the angle of growth, which significantly interferes with neighboring teeth and leads to the formation of a malocclusion.

Indications for extraction of a dystrophic tooth are:

swelling of the gums and pain;
numbness of the face due to damage to nerve endings;
pronounced curvature of adjacent teeth;
periodontitis or chronic pulpitis;
when, due to a problem tooth, it is impossible to perform prosthetics;
if a dystrophic tooth is the cause of periostitis or osteomelitis.

The removal process itself is similar to the procedure for removing an impacted tooth.

Tooth root removal under anesthesia

As a rule, root removal is performed under local anesthesia, but if the patient has a complex tooth root extraction, or if he has intolerance to local anesthetics or dentophobia, the specialist performs the procedure for tooth root removal under general anesthesia. This allows all manipulations to be carried out with complete comfort for the patient - while he is sleeping. However, this method has a number of serious contraindications: its use can have a negative effect on the heart, kidneys and brain. In addition, patients often experience nausea, headache, and confusion as they emerge from anesthesia. Therefore, they try to resort to anesthesia only as a last resort, giving preference to sedation. This is a modern type of general anesthesia, which involves deep relaxation, during which the patient remains conscious and can contact the doctor, but with this type of tooth root removal, pain and stress are completely eliminated.

Example 6. Restoration of teeth 4 and 5, when only one root remains

In the next total work I would like to highlight the 4th and 5th premolars. In general, the girl’s situation was quite complicated initially at the time she contacted me. Both the lower and upper jaws were restored. Let's look at only the top one.

Front 4 teeth

- these are 1.2, 1.1, 2.1 and 2.2 were entirely made of composite material, under which caries developed. And the teeth we were interested in, 1.4, 1.5, 2.4 and 2.5, were covered with metal-ceramic crowns under which there were metal inlays. Today, such structures are rarely used in advanced dentistry, since the same Cerec technology allows you to achieve excellent results with one module “crown + tooth root”, rather than breaking the structure into an inlay and a crown with an additional adhesive layer. In fact, we place a crown at the root of the tooth with the function of the missing root. There will be a separate example on metal tabs a little later.

So, in the photo below, the crowns were removed, the inlays were removed and carious tissue was removed from teeth 4 and 5, leaving healthy roots

If only the root remains of a tooth, this does not mean that it cannot be restored. And let this tooth root be pulpless, i.e. dead - such tooth roots feel great in bone tissue and orthopedic structures can be built on them. Using computer technology and 3D scanning, we first restored virtual teeth:

The following photo shows that on one side we place crowns with an inlay function in place of the 4th and 5th teeth, and on the other opposite side we place half-crowns also with an inlay function.

That is, these are single modular designs - veneers with a root part, which are currently the best for the patient

Installing veneers with the root part allows you to completely recreate an aesthetically beautiful dentition:

The stage of temporary prosthetics, which allows the patient to see his smile, plays an important role in the very process of its new formation, since the patient understands that the main problems with the restoration of the remaining teeth, and in fact the roots of the teeth, are left “far behind”:

After installing crowns and half-crowns and restoring the front teeth, our patient’s smile was transformed beyond recognition, the so-called. wow effect:

The clinical example described above can be viewed in detail HERE.

Tooth root amputation as a treatment

In some cases, complete tooth root removal can be replaced by a tooth-saving operation called amputation. This is the removal of part of the tooth root, allowing you to save a healthy fragment. During the procedure, the affected area is cut off and the cavity is filled with osteoplastic mass.

Tooth-preserving extraction operations also include hemisection, in which part of the root system is removed along with the adjacent crown area. These two methods allow you to preserve the physiological function of the tooth and use it to install a bridge. It is important to understand: no doctor can guarantee that such a tooth will last a long time, since partial loss of the root will lead to a violation of the stability of the tooth. Therefore, if you notice that for a long time after root removal the tooth hurts or causes you other discomfort, you should definitely contact your doctor.

Do I need to remove rotten teeth?

If a tooth root or crown is completely rotted, it cannot be restored. Such a tooth cannot be left in the jaw so that its purulent contents do not spread to the surrounding tissues. If there is rot in the root canals, it is not possible to make artificial crowns, since they will not be able to fix on the destroyed tissues. Therefore, in advanced situations, dentists prescribe the removal of a rotten tooth, and this operation cannot be refused. After removal, a course of antibiotics may be prescribed.

To prevent your teeth from rotting, you need to regularly monitor their condition. To maintain dental health, you need to adhere to a nutritious diet and maintain oral hygiene, as well as promptly treat any dental and internal diseases. Purulent processes are extremely dangerous, therefore, if the carious process has reached an advanced stage, you should not refuse to remove the diseased tooth.

How much does tooth root removal cost?

As a rule, the price for tooth root removal is determined based on the complexity of the case, and can vary greatly depending on the segment of the clinic, the qualifications of the doctor and other factors. Standard removal starts at an average of 3,000 rubles, complex removal will cost at least 5,000 rubles. Your attending physician will help you make more accurate calculations based on the diagnostic results. In any case, the sooner you go to the clinic, the less likely it is that complications will develop, especially since modern dental offices have all the capabilities to carry out the procedure efficiently and minimize the unpleasant consequences of tooth root removal.