My first extraction was a periodontally involved lower incisor. I was pretty happy, it’s as straightforward as it gets. With the support of my two other classmates I managed to anaesthetise the patient and was ready to start the extraction. We had the close oversight and support of Dr Stuart McEachen, an excellent OMFS and teacher. I luxated, then with forceps and with Dr McEachen’s hand guiding me, I proceeding to fracture off the root tip.

Welcome to exodontia!

Fortunately with just a probe and about 5 seconds, Dr McEachen removed it with ease.

Years on I still laugh at that first tooth and although much less, I still manage to break a root tip hear and there. The difference is I now have the skills to manage these situations.

35 H File to the Rescue 

A tip that I have seen come up time and time again on DPR is the root tip removal with a H file. It sounded like a pony trick until I first had a situation where I tried it – and it worked a treat!

If you have a fractured root tip that is mobile yet surrounded by firm intact bone, give the H file trick a go. I generally use a 35H and screw it into the canal a few turns. You want it to bind well but over doing it can fracture the file (trust me). Once bound, firmly pull and with a little luck, the stubborn root tip will pop right out.

A word of warning – floss tie the file if you want to avoid the stress of a swallowed file!

I’m sure you were taught to do root canal treatment with the rubber dam. One of the main reasons is to protect the patient from inhaling or ingesting a pointy 25mm file. This is clearly a situation where this is a risk and even the best have learnt this the hard way. Dr Lincoln Harris has a story where while a dentist was observing him, this exact thing happened and a patient swallowed a file.

Another Tool for the Toolbox

Dr Andrew Thorpe has kindly shared an alternative technique to removing the fractured root tip.

Using a surgical handpiece cut a buccolingual slot in the root tip that doesnt pass all the way through. Jam a fine luxator into the slot and rotate. Of course, be mindful of what is underneath! Don’t go pushing into the sinus or IAN.   

David is a recent graduate dentist working in private practice in regional NSW, Australia. Read more at www.dentalheadstart.com/meet-david/

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