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A Simple Technique for Removal of Broken Root Tip of Maxillary Premolars: A

Technical Note

Article  in  Journal of Maxillofacial and Oral Surgery · September 2015

DOI: 10.1007/s12663-014-0696-7

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A Simple Technique for Removal of Broken
Root Tip of Maxillary Premolars: A
Technical Note

Charanpreet Singh, Divashree Sharma,

Vilas Newaskar & Deepak Agrawal

Journal of Maxillofacial and Oral

Surgery

ISSN 0972-8279

J. Maxillofac. Oral Surg.

DOI 10.1007/s12663-014-0696-7

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 Author's personal copy
J. Maxillofac. Oral Surg.
DOI 10.1007/s12663-014-0696-7
TECHNICAL NOTE
A Simple Technique for Removal of Broken Root Tip of Maxillary
Premolars: A Technical Note
Charanpreet Singh • Divashree Sharma •
Vilas Newaskar • Deepak Agrawal
Received: 14 March 2014 / Accepted: 13 September 2014
Ó The Association of Oral and Maxillofacial Surgeons of India 2014
Abstract
Introduction Therapeutic extraction of maxillary premo-
lars is often indicated for orthodontic treatment. Extraction
as well as retrieval of broken root tips in cases should be
minimally invasive aiming to preserve the alveolus as well
as the buccal and palatal cortical plates.
Materials and methods Here a technique is described that
we have been employing for retrieving broken maxillary
premolar root tips which have the bevel towards the buccal
cortex.
Conclusion The method is simple, atraumatic and
effective.
Keywords Root tip
Maxillary premolar
Probe
Extraction of maxillary and mandibular premolars is rou-
tinely advocated for orthodontic treatment. In such cases it
is very important for the maxillofacial surgeon to follow
atraumatic extraction technique and preserve integrity of
C. Singh
Department of Oral and Maxillofacial Surgery, Government
College of Dentistry, 96 Radiocolony, Indore 452001, MP, India
D. Sharma (&)
Department of Oral and Maxillofacial Surgery, Government
College of Dentistry, Room No. 3, Indore 452001, MP, India
e-mail: divashri.19.sharma@gmail.com
V. Newaskar
Department of Oral and Maxillofacial Surgery, Government
College of Dentistry, 301 Chanakya Apartment, Plot 59,
Srinagar, Indore 452001, MP, India
D. Agrawal
Department of Oral and Maxillofacial Surgery, Government
College of Dentistry, 105 Metropride, Janki Nagar,
Indore 452001, MP, India
buccal and palatal/lingual cortical plates. For extraction of
maxillary premolars with forceps more of buccal move-
ment is made as compared to palatal, and more likely root
to fracture is the buccal root owing to its thinness. Poor
extraction technique while retrieving this root can result in
fracture of buccal cortical plate and fragmentation of bone
around the socket.
Various techniques have been documented in literature
for removal of broken root like creating a bony window
above the root apex [1] or surgical removal of bone around
the root within the socket and retrieving the root fragment,
removal with apex elevators, periotome, luxators [1] syr-
inge needle [2] or by engaging endodontic ‘‘H’’ file within
the root canal [3].
We have developed a simple atraumatic technique for
removal of broken root tip of maxillary premolars. The
basis of the technique is the thinness of buccal cortical
plate in maxillary premolar area [4]. This technique is
employed for broken roots with bevel towards the buccal
cortex. An envelope flap on buccal side is raised corre-
sponding to the tooth and a sharp probe is introduced
within the socket, after which the tip of the probe is
directed towards the buccal cortex along the direction of
the bevel of the broken root. The probe is advanced with
gentle force until it penetrates the full thickness of the
buccal cortex creating an opening and its tip is visible
buccally. The probe is withdrawn out of the socket. It is
then inserted into the opening externally to engage the
broken root and downward force is exerted to push the root
tip occlusally facilitating its removal. Mesial and distal
interdental papilla are positioned back with 3-0 braided
black silk sutures (Figs. 1, 2, 3).
The advantages of this technique includes minimal
periosteal stripping, preservation of bone, reduced operat-
ing time, no requirement of any additional armamentarium
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 Author's personal copy
Fig. 1 Picture showing broken root of maxillary left premolar. Black
line indicating the bevel of broken root piece towards buccal side
Fig. 2 Arrow showing position of the probe and its tip after
penetrating full thickness of buccal cortex
or assisting surgical personnel and elimination of the
apprehension of the patient, associated with the noise and
123
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J. Maxillofac. Oral Surg.
Fig. 3 Introduction of probe from outer aspect of buccal cortex to
engage the broken root piece
vibration of surgical hand piece. The only disadvantage is
that it is a technique sensitive procedure, however which
one can master with expertise.
This technique has been successfully implemented in
our department in more than 20 patients. It is concluded
that the technique is simple and very effective for
retrieving broken buccal root tip of maxillary premolars.
Conflict of interest None.
References
1. Dym Harry, Weiss Adam (2012) Exodontia: tips and techniques
for better outcomes. Dent Clin North Am 56:245–266
2. Orr DL 2nd, Haworth G (1985) Root tip recovery via local
anesthetic needle. Oral Surg Oral Med Oral Pathol 60(2):158
3. Stoner Kenneth E (2002) Using a Hedstrom endodontic file to
retrieve a root tip. JADA. 133(4):473
4. Histology Antonio Nanci Ten Cate’s Oral (2008) Development,
Structure, and Function. Elsevier Health Sciences, Amsterdam