Kase of the Month - Root Amputation Procedure
What would you do if a patient presented with a failing root canal retreatment or a failing apicoectomy?
Dental Root Amputation Procedure
Dental root amputation is described as the surgical removal of one of the roots of a multi-rooted tooth. This procedure is carried out to remove disease, to prevent further bone loss and/or to remove part of the tooth that has a tooth fracture. This procedure is indicated in patients that present with a failing root canal retreatment (RCT) or a failing apicoectomy. This option is worth exploring if a patient wants to save their tooth. Dental root amputation may prolong the viability of a tooth for a few years. Case selection is of utmost importance prior to performing this procedure. Long-term survival rate of a resected tooth is 83% at five years and 68% at ten years. Lower molars usually fail due to root fracture while the upper molars usually fail due to periodontal breakdown progression.
A 64-year-old patient reported to the office with sinus tract on upper right first molar. On tracing the sinus tract, it was found to be originating from the mesiobuccal (MB) root of the first molar. The tooth had been retreated twice and had developed a sinus tract. There was extensive bone loss around the MB root. A CBCT was performed and a perforation was noted in the middle third of the MB root. The remaining two roots of the tooth had good bone support. Patient was given the options of extraction or of removal of the perforated root. Patient wanted to save the tooth so she decided to go for the root amputation procedure. The root amputation procedure was done whereby the MB root was surgically removed with the help of a surgical bur. The removal of the problem root was necessary to remove source of infection. After the root amputation was completed, occlusion was adjusted to ensure all occlusal forces were being directed to the remaining roots.
Indications for Dental Root Amputation
- Severe vertical bone loss involving only one root in a multi-rooted teeth
- Furcation involvement with a through and through lesion
- Prevention of adequate hygiene maintenance in proximal areas due to proximity of roots of adjacent teeth
- Presence of dehiscence causing severe root exposure
- If there is perforation through the floor of the pulp chamber or pulp canal of one of the roots then the tooth can be saved by removing the root with the perforation.
- If vertical fracture is present in one root but other roots are unaffected, the fractured root may be removed.
- Caries in the furcation