How a tooth is removed if only the root remains. When is root extraction indicated? How does the root of a tooth come out?

Patients often do not seek help in a timely manner when the tooth is severely damaged. Afraid that you will have to cut the gum. The gum is cut into rare cases, and any manipulation in the dentist's office is carried out under anesthesia, so you should not be afraid of something. This article will discuss how a tooth is removed if only the root remains.

The technique for extracting the root of the tooth will depend on the clinical situation. Situations can be different:

The root in the bone was preserved after the destruction of the crown part of the tooth by a carious process.
The root in the bone was preserved after the injury.
The root in the bone was preserved after a difficult one, accompanied by its breaking off.

If the root in the bone remains after the destruction of the tooth by caries, it is usually highly pigmented and mobile. Its removal is not difficult. Usually it is possible to extract it with conventional dental forceps with elongated cheeks. If the forceps cannot cope with the situation, then first loosen the root with an elevator, and then remove it from the hole with forceps. In this case, cutting the gums is resorted to only when the root has been close to the bone for a long time and the gum has managed to close the defect.

If the root remains in the bone after an injury or after a complex removal, then the procedure for extracting it will depend on the depth of its location. After anesthesia, dentists first try to remove it in traditional ways: with an elevator and forceps. As a rule, such roots are not visible to the naked eye, the doctor studies its location on an x-ray.

If the traditional removal method fails, then try to remove it using a chisel and hammer. The chisel is placed in the space between the bone and the root and lightly tapped on it with a hammer. This usually loosens the root, and it is easily removed from the socket with forceps.

Surgical removal of the root of the tooth

How is a tooth removed if only the root remains, when none of the methods described above helped? In this situation, resort to surgical intervention.

Both local anesthesia and general anesthesia can be used as anesthesia. Either way, the patient will not feel pain.

The operation technique is as follows:

After the onset of anesthesia, the doctor makes an incision in the muco-periosteal membrane in the projection of the pathological focus.
Peel off the flap.
If the root is not visible to the naked eye, the bone plate is trepanned under water cooling so as not to damage the bone matrix and prevent bone atrophy in the future.
If the root is visible, then they simply cut it out of the bone using small dental tools in the form of burs.
After extracting the root, curettage of the hole is carried out, all fragments are removed.
The mucoperiosteal flap is returned to its place and sutured.
A gauze pad is placed on the wound for half an hour or 40 minutes to stop the bleeding.
Some doctors place an anti-inflammatory powder on the swab to prevent the development of postoperative complications.

Surgical tooth extraction

Do I need to remove the root of a tooth?

Many patients after tooth extraction feel that something is left in the bone, but because of their fears, they do not go to the doctor in a timely manner. The remaining root may not bother you for the rest of your life. However, under certain conditions, inflammation can develop, accompanied by terrible pain, so when the question arises; “Do I need to remove the remaining tooth root?” The answer is simple: "Undoubtedly, and the sooner the better."
After the tooth has been removed and the root remains, what to do is the main question. It is necessary not to delay the visit to the doctor. Perhaps there is no root there, and the tongue cuts the sharp edge of the alveolar process. Then the dentist will simply grind it off and all discomfort will disappear. However, in order to accurately exclude the presence of a root, it is necessary to take an x-ray and probe the disturbing zone.

Tooth extraction, as well as the subsequent removal of the tooth root, are not the most pleasant processes and are very fearful for most people. Thanks to innovative technologies, modern medicines, various painkillers, the removal of roots and teeth is absolutely painless, you just have to survive a small injection into the gum of anesthesia and you will not feel anything anymore. But first things first.

The removal of the tooth root, the video of which is on our website, is one of the dental surgical interventions that delivers the least pleasant sensations. The procedure itself takes place in different ways, depending on several factors:

the size of the tooth itself;
the state of the surrounding tissues, the presence of defects;
localization.

This affects how simple or complex the procedure can be. In any case, it is necessary to contact only specialists with sufficiently high qualifications to perform such a surgical intervention in a dental office, where there is all the necessary equipment.

Removal of the roots of the teeth

The first difficulties may arise if the remnants of the tooth have penetrated the gum to a great depth. Most often, such problems appear if the tooth root has already been removed, the photo of which is presented on our website. But the intervention failed.

Possible symptoms of a sick horse tooth

Unpleasant sensations or pain are the first sensations by which it can be said that the root was damaged after an unsuccessful operation, or as a result of some kind of injury. At the same time, unpleasant sensations are not always expressed clearly.

When the patient has already gone through the extraction of the roots of the teeth without pain, but the root itself remains, some discomfort is felt for a long time. It seems as if something in the mouth is preventing movement. But the remains of the "teeth" do not always make themselves felt immediately. Sometimes you can identify the problem by taking an x-ray. But such cases are the exception rather than the rule. Patients are most often aware of what is happening to them.

Most are accustomed to ignoring the small signals of the body. And many refuse to visit a doctor unless absolutely necessary. Because of this, there are serious complications.

Remaining root. What complications are associated with it

The damaged surface will become infected if the damage is due to some kind of trauma. Did the root of the tooth remain in the gum, at least partially? Then you need to get rid of it as soon as possible. For damaged tissues, a special treatment is carried out, which is called sanitation. An infection with a chronic focus of inflammation is unacceptable even if the defects appeared due to caries. In this case, the inflammatory process can be activated on the ligamentous apparatus with gums and teeth.

How is the root that remains after the removal of the tooth itself removed?

Even small inflammations of a local nature often pass into the chronic form. The result is periodontal disease. The hole will heal, but with inflammation, this process takes much longer.

Sometimes, due to the fact that the root remains in the gum, pathological changes occur in the surrounding tissues.

How is a tooth pulled out if only the root remains? Many are mistakenly accustomed to thinking that this is a very unpleasant and painful procedure. In fact, there is nothing wrong with that.

The first step is anesthesia

Does it hurt to remove a tooth root? Basically, the answer is no. Although each organism may have its own characteristics. This applies to such phenomena as pain threshold and sensitivity, suspiciousness. Usually local anesthesia is used. It is used before proceeding to the operation. The analgesic effect will remain until the end of the intervention, if the dose of the drug is correctly calculated.

It doesn't matter if it takes a few minutes or up to two hours. In this case, the form of the disease and its localization will not play an important role, as well as the instrumentation used.

What instruments do surgeons use?

Removing a rotten tooth root involves the use of different tools, depending on which group the diseased part belongs to. Devices are prepared even before the operation itself is carried out.

Elevators and tongs are the main, but by no means the only helpers. These devices are similar to levers in their action.

The process of removing the root of the tooth with forceps

What forceps are used in practice:

For processing the jaw below, if its opening is somehow limited.
With the help of which the extraction of teeth of the root type, large first and second, is carried out.
Used on separate groups, both above and below.
For those places where the crown has been preserved.

Any tongs has its own characteristics, its own design. It all depends on what they are intended for, depending on the location and structure. But they help to carry out the work qualitatively, if after the extraction of the tooth there is a root in the gum. Features of the structure in the crown can also affect which tool a particular specialist uses. As well as how many roots the patient has.

For example, a direct type of forceps is used when removing incisors from the side or in the center. Need devices in the form of the letter S, if you want to process small molars that are on top. The beak shape is needed when it comes to individual teeth on the lower, in upper jaw.

What are elevators

There are only a few varieties of these devices that are most widely used.

Bayonet types.
With corner structure.
With straight shape.

Each doctor decides for himself what and when to use, depending on the characteristics of the patient. Elevators also work as levers.

Principles of tooth root extraction

When carrying out the procedure, they follow a different order, as already mentioned. This is influenced by the presence of changes in the surrounding bone tissue, the integrity of the tooth and the degree of its damage, location.

There is a specific procedure for situations where there is no inflammation. The surgeon uses a trowel or a narrow flat rasp, while the circular ligament is separated from the neck of the tooth. Separate the gum and alveolus with each other. This is also done if the root of the tooth rots. What to do? Contact a specialist immediately. The imposition of forceps is carried out carefully and carefully, at the last stage.

If the bone tissue has melted a little due to inflammation, it is easier for the specialist to use forceps and make sure that they are located deep enough. In this case, you do not even need to use additional tools.

Sometimes a rotten tooth root cannot be removed using forceps alone. In this case, the elevator will become an indispensable assistant. They are introduced into the inter-root space, or into the place between the hole and the root part. Straight elevators are most useful when removing roots on the jaw at the top. Corner options help to process the bottom faster.

Painless tooth and root extraction

But even the combined use of these tools is sometimes not enough to solve the problem. Many difficulties arise not only if the tooth has rotted to the gum. What to do if there are several roots - this is really complex issue. Here you can not do without a drill. It will help to divide the "design" into several parts.

The wisdom tooth is the only part that can cause serious difficulties, while working with which the basic tools mentioned above are also lacking.

Wisdom teeth - removal features

Even if their development is normal, wisdom teeth are different from others. Their growth usually goes along the longitudinal axis of the jaw, perpendicularly. This means that they are located across the roots in other teeth. Because of this, complications arise even when everything is just cut.

How is a tooth removed if only the root remains, in which case? First you need to visit a surgeon. Only specialists with sufficiently high qualifications will appreciate how correctly this part of the body is located in relation to others. Conducting a subjective assessment is impossible in the absence of the coronal part, or with its complete destruction.

Then you can not do without the appointment of an X-ray examination. This is the main difficulty that arises when working with wisdom teeth. They can form completely even if the axis is wrong. When the diagnosis is carried out, the removal is carried out according to the usual rules, which have already been written about above. Physicians choose instruments based on the characteristics of their patients.

What else can be said about removing the root

We can say that this procedure is not so scary as everyone used to think.

In any case, the use of anesthesia is a mandatory requirement, regardless of the individual patient. It is better to discuss with your doctor in advance which painkillers should be taken if discomfort appeared after the operation. Antibiotics are prescribed local or complex action.

Smooth demonstration of the extraction of a tooth with a root in parts

It is enough to study this process at least a little to stop being so afraid, not only of him, but of the doctors themselves. The main thing is to have more incentives to seek help in a timely manner. Subsequently, the treatment can be much more serious and complex than at the initial stages, if the problem is started.

Human teeth are an organ that is subject to frequent destruction. This happens for a number of different reasons, from poor care to injury. But when the crown is destroyed as a result of damage to the dental tissue, the root (or several roots) remains in the gum. The question is whether to remove it. If the patient cares about maintaining the integrity of the dentition, and immediately after the loss of a tooth is sent to restore it, for example, to install an implant, removal is inevitable. But in most cases, people do not rush to the dentist to extract the root from the gum, which, as it seems to them, does not interfere and does not pose a danger.

Save or delete

Dentists try to preserve as much as possible at least one root on multi-rooted teeth during treatment. If possible, it will serve as a support for the restored crown, and the tooth will perform its functions in sufficient volume.

But after the complete destruction of the dental tissue, if the carious process has reached the roots and completely captured them, it is better to remove the pathogenic focus of infection from the gums as soon as possible before it spreads to a large area, damaging neighboring teeth.

Removal of a root with a destroyed tooth crown is a complex surgical procedure. Patients quite deservedly consider it one of the most unpleasant. And although today, due to the high level of development of anesthesia, the process is not as painful as before, the fear of this operation in patients remains.

By the way. Fortunately, in most cases, it is not necessary to remove all the roots of a tooth. If the carious lesion is not captured at the last stage, it is enough to treat the remaining roots, and subsequently resort to prosthetics or tooth restoration.

But when the carious process has destroyed the roots to the ground, if they are rotten through and through, they must be parted as quickly as possible.

A rotten root is a breeding ground for infection. The longer it is present in oral cavity the more problems it creates.

Most often, patients with neglected rotting roots left after a tooth crown fell out or chipped off come to the surgeon for emergency help with the words: “The rotten root didn’t bother me for so long, it didn’t hurt, and then suddenly my whole cheek was swollen.” Of course, this does not happen all of a sudden. A natural given that will happen 100% at the most inopportune time if you have a damaged root in your mouth.

Important! It is practically impossible for a patient with a flux to perform a painless root extraction, since anesthesia must take into account the projection of the roots into the gum tissue, but this place is filled with pus. In some cases, it is necessary to make an incision in the gums for the outflow of purulent masses, carry out disinfection and send the patient without removing the ill-fated root. And not all patients return at the time prescribed by the doctor in order to still have an operation to remove it. Many leave everything as it is, waiting for a new flux.

Indications for removal

If none of the tooth-preserving techniques can be used, the roots of the tooth are removed. There are a number of situations where surgery is unavoidable.

Table. The need to remove the tooth root

Reasons for deletion	Description
	Complex transverse fracture, fracture along the lobar, or fracture of the dental crown.
	Near the root is a focus of inflammation. It can be a cyst, phlegmon or abscess, as well as in the case of osteomyelitis and periostitis.
	There are three degrees of root mobility, the last of which, the third, is an indication for its removal.
	The dental crown is completely destroyed below the level of the gum tissue
	Atypical location of the tooth root to be removed.

The crown can be destroyed both on a “live” tooth and on a “dead” one. In the first case, the root is not badly damaged, and it can be saved. A pulpless tooth almost always has a severe degree of root damage, and it cannot be restored using prosthetic techniques by extending the crown part. Root extraction and implant restoration is shown here.

By the way. With regard to the roots of the back molars, the situation almost always requires their removal.

These are the most complex and problematic teeth located in the far part of the jaw closure, which are difficult to care for. Therefore, hygiene is not carried out in full, and their destruction is faster than the rest.
In the process of eruption, the back molars often cause displacement of the dentition, breaking the bite.
Often they provoke chronic injury to the mucosa, as a result of biting through the mucosa from the inside of the cheek. This can lead to permanent inflammation and the formation of malignant tumors.

Since there is no need to restore the crown part, which often does not even cut through the gum tissue in full, there is no need for wisdom teeth, when they wrong growth or destructive carious lesions, the back molars are removed along with the root.

From dental practice

There are many situations in which it is necessary to make a decision to remove or preserve the roots. An inexperienced dentist, for example, insisting on keeping a half-decayed root for a bridge, may be wrong if:

the root has high mobility (the prosthesis will be mobile along with it);
necrotic processes destroyed the interradicular septum;
at the root tip (narrow part) the focus of inflammation is localized;
the root has a low functional value.

The latter means that even if the root can be preserved therapeutically, it is not always advisable. Even with a partially restored root, the restored coronal part attached to it may not fully function.

Better extract:

roots of back molars;
teeth that do not have antagonists (therefore, they cannot perform a chewing function);
roots of teeth emerging from the dentition.

How are the roots removed?

There are many methods for removing tooth roots in dentistry. But patients are always intimidated when it comes to root removal with a completely or largely destroyed crown.

By the way. If the root is quickly removed from the gum before it has completely collapsed, the operation will not be the most difficult. With the help of forceps with “cheeks”, even without tissue incisions (if the root is not completely tightened by the gum), the operation to remove the root of average complexity lasts about ten minutes.

The least difficult is the removal of the root in patients from forty years of age and above. In mature and advanced age, the alveolus atrophies, the height of the inter-root partitions decreases, and in almost all cases when the crown is destroyed, an inflammatory process forms in the root. Therefore, it is, as it were, pushed out, rejected by the body.

In younger patients, the hilar tissue usually remains healthy. When two or more roots are planned to be removed, the operation is considered difficult.

Instruments of a dental surgeon

Once upon a time, the roots were literally hollowed out of the jaw with a chisel and a hammer (special dental, not construction, but it still hurt).

Today, the root is removed by sawing out of the gum tissue with a drill and extracting it piece by piece with an elevator.

Cases when the root has to be hollowed out from the gums were recorded in only 2% of patients.

Anesthesia is complete and effective, and pain is minimal, as is the case with extraction of a tooth with a preserved crown part.

Unbelievable but true

Even today, in the 21st century, and by no means the inhabitants of "dense" villages, but quite civilized and educated people are trying to remove the root of a destroyed or dilapidated tooth on their own with the help of pliers. The fear of going to the dentist is so great that, having taken a glass of vodka as anesthesia, the patient tries to grab the base of the root with this tool, believing that after that it will not be difficult to pull it out.

Of course, when trying such a removal, which usually fails:

an infection is introduced into the wound;
pain shock occurs;
part of the root is crushed, filling the wound with fragments, which subsequently rot;
complications arise.

Complications after removal

It is worth noting that complications are not uncommon after a root extraction operation by a dentist. True, this applies to not very experienced doctors who do not have much experience in such operations.

Due to inattention, negligence or due to unprofessionalism, fragments of the root remain in the wound. The doctor reassures the patient, assuring that the parts that are not removed will subsequently come out of the gums on their own. Of course, this does not happen.

With severe removal, the surgeon can create a situation where the root tip breaks off. It is not always possible to notice, because from the wound there is blood. Experienced dentists in such cases postpone the appointment, prescribing a second removal to the patient.

Important! Leaving a broken off fragment of the root in the wound is unacceptable. Yes, for a long time this fragment can be in the gum without causing concern to the patient. But it will move to the surface, along the fistulous canal. And if there was a cyst at the top, then even after several years of “serene” behavior, the remnants of the root can provoke a flux.

The second unpleasant situation may arise with a seemingly successful outcome, when the rest of the root tissue was dragged on by the gum and was closed in a capsule of gum tissue. Such a “delayed-action mine” will definitely provoke a phlegmon or an abscess, as well as cause periostitis and osteomyelitis.

Sometimes a situation arises, the root is removed completely and cleanly in depth, but fragments are stuck in the gum tissue at the top. This is the most common negligence of the surgeon, which the patient must control. If you feel that life has not improved after removing the rotten root, see another doctor. Listen to the opinion of at least three dentists in order to avoid alveolitis or other diseases later.

Summary

In modern dentistry, everything is not as scary as it seems. For any pain threshold The patient is given local anesthesia. The anesthetic will remain effective throughout the procedure and up to two hours after it.

With the beginning of the action of the anesthetic, the jaw becomes numb. Then modern lever elevators will quickly remove the remnants of plaque, food and other third-party organisms to open access to the root. You need to extract it. Therefore, the best thing you can do if you have a root in your mouth is to go to the surgeon and find out if it is worth it to carry out its planned timely removal, so as not to cause serious pathological complications.

Video - Removing the roots of teeth

In what cases may it be necessary to remove the root of the tooth, or part of it (for example, resection of the apex);
Why “rotten” tooth roots should be removed as soon as possible and what can await you if you do not do it on time;
In what cases can the roots of the tooth still be preserved (for subsequent prosthetics) and by what methods is such preservation implemented;
Typical clinical situations when a tooth root is to be removed (and what is useful to know if, for example, a significant piece has broken off a tooth while eating);
Ways to remove the roots of teeth, from simple to complex and traumatic (using a dental chisel and hammer);
What to do if, after tooth extraction, a root or small fragments remain in the hole ...

Sometimes the crown part of the tooth is so severely destroyed that only the root of the tooth, eaten away by caries, remains - in such cases, the question usually arises of removing these “rotten” residues. Often there are annoying injuries: for example, while eating, a piece of a tooth can break off, and the chip (or crack) sometimes goes deep under the gum - in this case, the removal of the tooth root may also be required.

A separate story, when the tooth is outwardly more or less functional, but the state of its root (or roots) is far from normal - there are cysts, granulomas. Then the dental surgeon may suggest resection of the apex of the root or even amputation of the entire root of the tooth. We'll talk about this a bit more below...

Fortunately, in some cases it is not necessary to remove the root of the tooth, and it can be limited to its treatment with subsequent prosthetics or restoration of the crown part of the tooth. However, it should be understood that the remnants of a tooth (“rotten through and through” roots) strongly destroyed by the carious process should be parted as quickly and without regrets as possible, since their preservation does more harm than good to health.

Just with this, let's start - let's see why, in fact, it is necessary to remove the destroyed roots of the tooth as soon as possible ...

Why should decayed decayed tooth roots be removed?

From the point of view of a dentist, the situation when a patient walks for years with a rotten tooth destroyed to the ground looks like this: this person does not feel sorry for himself. The fact is that in such cases, the roots of the teeth must be removed urgently (see the example in the photo below).

The reason is simple: rotten roots are a breeding ground for infection, and the more of them in the mouth, the more pronounced the problems, and they are far from being limited to constant bad smell from mouth. These porous "rotten" absorb bacteria and food particles like a vacuum cleaner. In addition to rotting food, there is also hard-to-remove plaque on the remains of the tooth and almost always supra- and subgingival tartar, which is why the gums also begin to suffer.

In almost 100% of such cases, an inflammatory process is observed on the tops of rotten roots, accompanied by rarefaction of bone tissue, a granuloma or cyst is formed. Simply put, a purulent sac hangs at the top of the root, which is just waiting in the wings to break through with the formation of a "flux".

The photo below shows an example of extracted teeth with cysts on the roots:

Against the background of the vital activity of microorganisms, human immunity is forced to constantly spend its resources on fighting infection in order to somehow compensate for this problem (frequent diseases can be observed).

If such a tooth root is not removed, sooner or later the moment comes when the forces of the body can no longer prevent the spread of infection - an acute inflammatory process will occur, often accompanied by significant swelling. The favorite phrase of such patients is: “For so many years the root has rotted, it didn’t hurt, and then suddenly my cheek was swollen, and as always at the wrong time.”

On a note

And how, one wonders, to such a patient with a “flux”, to whom the slightest touch of the gum causes severe pain, the dentist should painlessly carry out the removal of the root of the tooth? After all, anesthesia is almost always done in the projection of the roots of the tooth on the gum, and there at that moment a significant amount of pus accumulates. The surgeon has a choice here: somehow try to make the anesthetic injection as painless as possible, cut the gum, releasing pus, and send the patient home, and after a few days, when he feels better, calmly remove the destroyed tooth root.

Or you can remove it here and now, but in this case there is a very high risk that root removal will be painful.

As you can see, it is not worth delaying the removal of rotten tooth roots - they must be removed, and the sooner the better.

In what cases can the roots of the tooth be preserved, and by what methods is this implemented?

Suppose that you have such a tooth (or even several) in the oral cavity, which is already difficult to call a full-fledged tooth due to destruction, but it also falls under the category popularly called “root”.

For example, for a long time there were large fillings on dead teeth, which for some reason fell out, and only “horns and legs” remained of the tooth: one or two walls or the remains of the walls of the tooth. Or, for example, while eating, a significant piece broke off from a molar, and only a “stump” with sharp edges remained.

Is it necessary to remove the roots of the tooth in such cases, or is it still possible to think of something to save them with subsequent prosthetics of the crown part?

So, today there are many so-called tooth-preserving techniques - the main ones are divided into conservative and conservative-surgical.

Conservative methods of preserving teeth do not provide for surgical interventions, and preservation of the root (tooth stump) is carried out by preparing channels (if necessary) and restoring the coronal part with a suitable method, for example, using restoration with a light-cured material using a pin, or inlay and crown.

A conservative surgical method may be required when there is an inflammatory process at the apex of the tooth root: after filling the canals of the tooth (most often with dental cement), resection of the apex of the root is performed on the same day or delayed. This operation is usually performed under local anesthesia and can be performed on both single and multi-rooted teeth. The operation is generally simple and usually takes 15-30 minutes.

However, sometimes with an inflammatory process at the top of the root or even the roots, it is possible to do without surgical procedures- if it is possible to carry out treatment by introducing an anti-inflammatory agent into the canal (canals), then the dentist puts the drugs for a certain period (from 2-3 months to 1-2 years) with the expectation of bone restoration around the root apex. With a significant loss of bone tissue, the doctor will most likely still choose a conservative surgical method - either as the only way to save the tooth, or in order to reduce the treatment time (not a year, for example, but 1-2 months).

On a note

Resection of the apex of the tooth root is carried out in several stages. At the first stage, there is preliminary preparation (taking an anamnesis, especially for allergies, processing the surgical field) and anesthesia (most often with articaine drugs).

The second stage involves the beginning of the operation itself: creating access to the root apex through the gum incision, exfoliating the soft tissues, cutting out a special small “window” in the bone and detecting the problematic root.

At the third stage, a part of the root with a cyst or granuloma is cut off with a drill, after which preparations are placed in the wound to stimulate the growth of bone tissue and accelerate healing. The wound is sutured. Prescribing drugs for home treatment(including painkillers) allows you to minimize possible pain and allows the patient to return to normal life in a matter of days.

Significantly less popular techniques to prevent the removal of the entire tooth are hemisection and root amputation.

During hemisection, the affected root is removed with a part of the rotten tooth crown, and healthy roots with the remaining whole crown part are left for prosthetics.

Amputation of the tooth root, unlike hemisection, does not involve excision of the crown part: only the root (entire) is removed with a cyst or granuloma present on it.

It is interesting

Exclusive options for preserving a severely damaged tooth are coronary radicular separation and tooth replantation (for example, if the tooth was knocked out due to mechanical impact).

Coronary radicular separation is carried out in relation to large molars, when there is an inflammatory focus that cannot be treated in the area of the bifurcation or trifurcation of the roots (where the roots branch out). The tooth is cut into two parts, and the affected tissues between the roots are removed. Subsequently, each segment of the tooth is covered with soldered crowns with the restoration of the lost function of the dentition.

Tooth replantation - simply put, this is the return to the hole of a tooth that, for one reason or another, was previously removed from it (on purpose, or, for example, was knocked out by accident upon impact). Sounds incredible, but true. To date, such operations are rarely performed, usually in cases where the tooth is brought to the dentist freshly knocked out.

In Soviet times, when they were not available modern methods preservation of complex destroyed roots, such methods were more or less popular for various options for unsuccessful conservative treatment. For example, a dental surgeon could carefully remove a tooth beforehand, and a dental therapist performed intracanal treatment with filling and (sometimes) resection of the root apex (amputation, hemisection). The prepared tooth (or part of it) was fixed back into the socket for former place with the help of splinting with exclusion from the bite for several weeks.

Due to the technical complexity and not always justification, today the method of replantation of teeth is used only in exceptional situations.

In what cases the root will still have to be removed

If none of the tooth-preserving techniques can be applied, then the roots of the tooth must be removed.

The following are the most common situations in the practice of a dentist that involve the removal of tooth roots:

With complex fractures of the tooth (for example, with a longitudinal one - see an example in the photo below);
Against the background of serious inflammatory processes near the root (large cyst, periostitis, osteomyelitis, abscess, phlegmon);
The destruction of the crown of the tooth is significantly below the level of the gums;
Mobility of the root of the III degree;
Atypical position of the destroyed tooth (various dentoalveolar anomalies).

And some others.

However, as noted above, not with every tooth fracture, the remaining roots have to be removed. A fragment can break off both from a living tooth and from a dead one, that is, previously depulped, and the dead ones are more vulnerable in this regard, as they become brittle over time. So, if the root is not badly damaged and has a solid base, then the tooth is restored by the usual methods: the canal is treated (if the tooth was alive) and the crown part is restored using restoration or prosthetics.

With regard to the roots of wisdom teeth, there are nuances: many patients are in a hurry to get rid of such teeth as soon as possible - the reasons may be different:

Sometimes the hygiene of wisdom teeth is difficult and they are rapidly destroyed due to caries;
Erupted wisdom teeth can cause displacement of the remaining teeth in the dentition, which often leads to malocclusion;
Sometimes eights lead to regular biting of the cheek, that is, to chronic trauma to the mucous membrane, and this is dangerous with the risk of malignant tumors.

Etc. However, before rushing to remove the eights, it is worth taking into account the fact that there are cases when even a seemingly badly damaged wisdom tooth is important for removable or fixed prosthetics. Not all people can afford the installation of dental implants to "scatter" even such teeth.

Therefore, in certain situations, the dentist can save the roots of the wisdom tooth by carrying out their full endodontic treatment and restoration of the tooth (for example, with an inlay), followed by its use as one of the supports, for example, a bridge prosthesis.

From the practice of a dentist

In fact, most dentists rather conditionally adhere to the list of indications for the extraction of a tooth or its roots. The fact is that a practicing doctor over the years of work forms his own opinion about the possibility of saving a tooth in a particular clinical situation (often this is the result of numerous trials and errors).

So, for example, an inexperienced orthopedic dentist may insist on preparing the roots of a certain tooth for a future bridge prosthesis, to which a competent and experienced dentist-therapist, for example, refuses, justifying this by the mobility of the root (or roots), destruction of the interradicular septum, obstruction canals due to the resorcinol-formalin treatment carried out many years ago, or a significant inflammatory focus at the root apex. Even one of the listed reasons is enough to abandon such an undertaking.

In addition, there is such a thing as “the functional value of the tooth”: even if the root of the tooth can technically be restored in an accessible way, this does not mean that without a detailed analysis of the entire clinical situation, it is worth immediately taking it up. Will the tooth be able to function normally in the future? If not, then there is little point in this preservation. For example, this applies to the roots of teeth that are outside the dentition, or wisdom teeth that do not have antagonists (that is, they are not capable of performing a chewing function as a result).

Ways to remove the roots of teeth: from simple to complex

In some patients of the old Soviet style, the doctor's message about the need to remove the root of the tooth causes almost panic. Usually such a reaction is associated with a number of the following fears:

“My lower left molar fell apart, they said that it was necessary to pull out the roots. Believe me, it hurts terribly, I myself went through this recently. And they also told me that I would not feel almost anything, they consoled me so that I was not very afraid. It's terrible, I burst into tears right in the chair, they even gave me a sedative. They shredded and pecked my jaw for an hour, the doctor was already sweating all over. The pain is wild, despite three injections ... "

Oksana, St. Petersburg

Fear of the dental office often leads to the fact that a person can walk for years with rotten tooth remnants in his mouth: he looks in the mirror - the root has not yet completely rotted and does not hurt, which means that you can still be patient. All this time, the remains of the tooth will be subjected to increasing carious destruction, which in the future may further complicate the process of root removal.

Meanwhile, if you do not pull to the last, then it will be quite easy for the dentist-surgeon to remove the roots of the tooth with forceps, with cheeks specially adapted for this. Even if the roots are partially covered with gums, incisions are not made. Moreover, the roots that have disappeared from sight have an access line, that is, the gum cannot completely close the “rotten” even over the years, so the dental surgeon can only slightly open them with a trowel and remove them with forceps. It usually takes about 3-10 minutes.

The photographs below show the extraction of a tooth, the crown part of which is destroyed almost to the level of the gum:

From the practice of a dentist

In patients in adulthood (from 40 years of age and above), the removal of rotten tooth roots in the vast majority of cases does not present any particular difficulties, since against the background of atrophy of the alveoli, a decrease in the height of the partitions and an inflammatory process near the roots, the body, as it were, “rejects” these roots, therefore often there is their mobility to one degree or another. Practitioners are well aware that the older the patient, the better, since removal, along with anesthesia, almost always takes a matter of minutes - to the delight of the patient and the doctor.

Now a few words about the chiselling of the roots of the tooth using a chisel and a hammer. There are difficult cases when there is a tandem of 2-3 or more roots, that is, there is a full-fledged partition between them, and the patient's age is relatively young, the bone tissue around the roots is full. In other words, a gift for a dentist-surgeon is clearly not expected.

In such cases, forceps rarely help in solving the problem, and a professional dentist takes on ... No, not a chisel and a hammer. Currently, the professional dentist prefers modern approaches to the removal of such roots: sawing with a drill and removing the roots individually with an elevator and (or) tongs. This is especially true of the sixth teeth and wisdom teeth.

Photo of a tooth whose roots are separated by a drill before removal:

Then in what cases do they still resort to a hammer and a chisel?

It is extremely rare, in the dense villages of central Russia (figuratively speaking), this technique is used - moreover, it is used as the main one, since the dental surgeon either does not know about the removal of roots with a drill and even hammers teeth with an almost complete crown, or he does not have a drill available (everything happens from the poor equipment of the cabinets).

As for pain during the procedure: when removing the roots of a tooth, anesthesia is performed in exactly the same quality and technique as when extracting teeth with a crown part. If a dentist uses an outdated anesthetic in his work and, moreover, does not professionally know anesthesia techniques, then the result will be disastrous, especially for the patient.

On a note

A rather actively exaggerated topic among the people - is it possible to remove a destroyed tooth on your own with the help of pliers? Even frightening (from a professional point of view) examples of removal by this tool are given. Firstly, in many cases, a diseased tooth, even with deep carious destruction, should not be removed, but it can be successfully cured by a dentist-therapist. Secondly, anesthesia is required for removal, and without it, the pain will be very severe. Thirdly, with such a tooth extraction at home, there is a high risk of introducing an infection into the wound with the subsequent development of complications. And this is not to mention the fact that many of the daredevils can simply crush or break off part of the tooth with pliers, leaving roots and fragments in the hole.

About situations when, after tooth extraction, its remnants remain in the hole

The fears of patients often relate not only to the fear of removing the roots of the teeth, but also to the prospect of possible leaving the remnants of the tooth in the hole due to the carelessness of the doctor (for example, a broken root with a cyst or splinters). Indeed, in practice, not very experienced specialists sometimes encounter such precedents. Interestingly, a number of such dentists are firmly convinced that everything will be in order, and they tell their patients: "Don't worry, over time the root will come out by itself."

What happens if the root of the tooth was not completely removed by the doctor?

With a difficult removal of the root of the tooth, the dentist often finds himself in a situation where the tip of the root (tip) breaks off, and increased bleeding from the hole closes the view for further actions (in other words, the hole is all filled with blood and it is problematic to see anything in it). The professional can either work blindly, relying on their experience, or postpone the appointment, competently explaining to the person what to do and when to visit him again to complete the work.

But if the doctor does not have much experience in tooth extraction, or fundamentally prefers the tactics of "non-intervention" (sometimes in order not to waste his time), then he advises the patient to simply wait for the root to "come out by itself". Say, do not worry, the problem will resolve itself.

Dentist's opinion

The practice of leaving a broken tooth root in the hope that everything will be fine is vicious. Indeed, in many cases, the left root or fragment may not bother for a long time, and the wound simply does not completely heal over the years - something like a canal or a fistulous tract remains, and the root gradually moves to the gum surface. It can take a very long time (up to several years), and there is nothing good for the owner of such an incompletely removed tooth: the infectious process at the top of the root continues its negative impact on the body.

Worst of all, it turns out in cases where the top of the root with a granuloma or cyst remains. Problems arise either immediately in the form of purulent inflammation on the gums (“flux”), or delayed, but they will almost certainly occur (they can happen even after 10 years). The most unpleasant situation is when the left root is tightened by the gum and a new bone is formed around it, that is, the rest of the tooth lies in a kind of capsule that separates it from healthy tissue. How much time will pass before all this makes itself felt is not important, but the later the visit to the dentist follows, the more likely it is that with the development of an exacerbation of the purulent process (periostitis, osteomyelitis, abscess, phlegmon), help will be provided already in hospital on the operating table.

Thus, if the tooth was not completely removed (after the tooth was removed, a fragment of the root remained in the hole), then it is advisable to take measures to bring the work started by the doctor to the end, and this should be done in the near future. This will allow not to leave the inflammatory focus for many years, despite the assurances of the attending physician to wait until everything goes away by itself. In such cases, it can be useful to go to another dentist without leaving a time bomb in your jaw.

After the extraction of a tooth, it may turn out that its roots are completely extracted, but at the level of the gums you will already find some small fragments at home. Moreover, the dentist in the picture can state the absence of roots in the hole, but will not pay due attention to the gingival margin. The point here is that a tooth destroyed by caries often crumbles during removal, and single fragments connected to the gum are not removed by the dental surgeon for a number of reasons:

Poor visibility due to bleeding of injured tissues;
Doctor's negligence;
Negligence.

If this debris remains in the hole (even small pieces of a carious tooth), then the risks of developing alveolitis, an infectious inflammation accompanied by pain, swelling, fever, general malaise and other unpleasant symptoms, increase to a certain extent. That is why a competent dentist not only removes all the roots of the tooth, but also examines the wound for the presence of small fragments of the tooth, pieces of bone (if the removal was difficult), filling material.

A clean wound heals, as a rule, much faster and more comfortably than a contaminated one, so it is so important to contact a dentist in a timely manner and clean the hole if anything foreign is noticed in it.

Is it possible to remove the root of the tooth yourself

Today, on the Internet, you can often see the appearance of video reviews about how people remove their own teeth at home. Moreover, there are not only video reviews, where adults and, to put it mildly, tipsy men pull out dilapidated teeth on their own, but there are also examples of self-extraction of milk teeth in children.

Let's see if it's worth experimenting like that?

Not only does it not look very attractive from the point of view of aesthetics (people writhe in pain, blood literally flows down their fingers), but the main concern is, first of all, the lack of sterile conditions during the procedure. You can’t talk about the professional component at all: if the removal of a more or less whole tooth is still somehow realized from the tenth time (provided that the crown part does not crumble into fragments), then the teeth that have been destroyed to the root are practically not amenable to self-removal.

Therefore, “pulling out” teeth at home (including loose milk teeth) is not even worth trying.

Interesting video: removal of the roots of two teeth, followed by suturing the wound

An accessible description of the instruments used in the extraction of teeth

The decision to remove the root of the tooth can only be taken by the attending physician - taking into account the patient's testimony in a particular case. If the affected tooth root is treatable, then the necessary procedures can be carried out and it can be 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 the tooth is broken or cracked and hurts, and the gum 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 provokes constant pain.
In the presence of a cyst that cannot be removed without removing the root.
If the wall of the tooth has broken off, and the resulting fragment goes under the gum.
When part of the root remains after tooth extraction.

Separately, it is worth noting the removal of the root of milk 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 the tooth is broken, and its remnant injures the gum; 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.

Is it possible to leave?

Some patients can walk for years with a tooth that has been completely destroyed, not realizing that rotting roots are a breeding ground for infection and, at a minimum, provoke permanent bad smell from mouth. Affected roots absorb, like a sponge, bacteria and food particles. Over time, plaque and stone form on the remnants of the root, due to which the gum tissue is already exposed to inflammation.

Often, patients ignore the problem, hoping that the removal of the root without a tooth is not required, as it will come out on its own. This is a big misconception - in rare cases, a fragment of a tooth can really come out, but not its root. Delay will only lead to the fact that the root will grow, because of which the gum will have to be cut in order to remove the root of the decayed tooth.

The constant struggle of the body with infection in the root area means that the human immunity directs part of the resources to solve the problem. Ultimately, this will provoke the development of infection and inflammation, and for patients it turns out to be a surprise every time. In some cases, if the decayed tooth root is not removed in time, the infection in the upper jaw can go to the maxillary sinuses, and in the lower jaw it can lead to a fracture or osteomyelitis.

Signs that a root is left after a tooth extraction

If the root in the gum remained during the extraction of the tooth, which 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, sharp pain under mechanical action, you observe redness or bleeding from the gums, elevated temperature - this with a fairly high probability may indicate the presence of a remnant of the tooth root. If, after the extraction of a tooth, a root remains in the gum, the consequences will not be long in coming. Therefore, as soon as you have such a suspicion, contact a specialist as soon as possible.

Stages of removing the root of a destroyed tooth

The operation of removing the root of a tooth is a procedure even more time-consuming than the removal of a whole tooth. Preparation typically includes a visual examination of the oral cavity, diagnostics using special equipment and sanitation. The results of the analyzes allow, in accordance with medical indications, age, state of health and other characteristics of the body, to draw up a treatment plan, as well as choose the best tools and anesthetics for the procedure.

How is root extraction performed without a tooth?

The doctor injects the patient with a local anesthetic, selected in such a way as to exclude allergies and other reactions of the body.

After 10 minutes (when the anesthetic has worked), 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 in the hole or has overgrown, then you will need to cut the gum and drill out part of the bone tissue to access the root.

Next, the root of the tooth is removed with forceps or a dental elevator. If the tooth has a multi-root system, it will first be divided using a drill or ultrasound, and then removed in parts. This is called complex deletion.

After removing the root of the tooth, the hole is treated with a special solution. If the gum was cut, then after the operation, sutures are applied and the operated area is treated with drugs that will help speed up healing.

Note! Root removal upper teeth somewhat different from removing the roots of a tooth mandible. The roots of the lower jaw are most often removed with elevators: the instrument is placed between bone tissue gums and root and rotate the handle. When removing the roots of the teeth of the upper jaw, bayonet-shaped forceps are more often used - medium for canines, incisors and premolars and wide for molars. With the help of a tool, the circular ligament of the tooth is first peeled off, then the single roots are twisted, and the interconnected ones 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 eights often grow at an angle, respectively, 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 in order to exclude the possibility that a root remains after the removal of a wisdom tooth.

Removal of the root of the tooth under anesthesia

As a rule, the removal of the roots is performed under local anesthesia, but if the patient has a difficult extraction of the tooth root, and also if he has intolerance to local anesthetics or dental phobia, the specialist performs the procedure for removing the roots of the teeth under general anesthesia. This allows you to carry out all the manipulations 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, in the process of coming out of anesthesia, patients often experience nausea, headache and confusion. Therefore, they try to turn to anesthesia only as a last resort, preferring sedation. This modern look general anesthesia, which implies deep relaxation, during which the patient remains conscious and can contact the doctor, however, with this removal of the tooth root, pain and stress are completely excluded.

Amputation of the root of the tooth as a treatment

In some cases, the complete removal of the root of the tooth can be replaced by a tooth-preserving 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 removal operations also include hemisection, in which part of the root system is removed along with the area of the crown adjacent to it. These two methods keep physiological function tooth and use it to install a bridge. It is important to understand: no doctor can guarantee that such a tooth will last for 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 the removal of the roots, the tooth hurts or causes you other discomfort, you should definitely contact your doctor.

How much does a tooth root extraction cost?

As a rule, the price of 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, a complex one will cost at least 5,000 rubles. The attending physician will help you make more accurate calculations, guided by the results of the diagnosis. In any case, the sooner you go to the clinic, the less likely it is to develop complications, especially since modern dental offices have all the capabilities to carry out the procedure with high quality and minimize the unpleasant consequences of tooth root removal.