Management of a tooth with internal resorption

# Which of the following is the BEST method for managing a tooth with internal resorption?
A. Pulpectomy and root canal therapy
B. Extraction
C. Svek pulpotomy
D. Pulpotomy with calcium hydroxide

The correct answer is A. Pulpectomy and root canal therapy.

Internal resorption in a tooth requires complete pulp removal followed by a root canal procedure.

Pulpotomy does not completely remove the pulp,  so the internal resorption will persist and probably progress if the pulp is not completely removed.

Grossly decayed mandibular molar removal

# While attempting to remove a grossly decayed mandibular molar, the crown fractures. What is the recommended next step in order to facilitate the removal of this tooth?
A. Use a larger forceps and luxate remaining portion of tooth to the lingual
B.  Separate the roots
C.  Irrigate the area and proceed to remove the rest of the tooth
D. Place a sedative filling and reschedule patient

The correct answer is B. Separate the roots.

This can be done with a chisel, elevator, or most easily with a bur.

Teeth with two or more roots often need to be sectioned into single entities prior to successful removal.

A popular method of sectioning is to make a bur cut between the roots, followed by inserting

an elevator in the slot and turning it 90° to cause a break.

Roots can be removed by closed technique. The surgeon should begin a surgical removal if the

closed technique is not immediately successful.

Indications for surgical extractions:

• After initial attempts at forceps extraction have failed

• Patients with dense bone

• In older patients, due to less elastic bone

• Short clinical crowns with severe attrition (bruxers)

• Hypercementosis or widely divergent roots

• Extensive decay which has destroyed most of the crown

Root most often dislodged into maxillary sinus

# The root of which tooth is most often dislodged into the maxillary sinus during an extraction procedure?
A. Palatal root of the maxillary first premolar
B. Palatal root of the maxillary first molar
C. Palatal root of the maxillary second molar
D. Palatal root of the maxillary third molar

The correct answer is B. Palatal root of the maxillary first molar.

If an entire tooth or a large fragment of one is displaced into the sinus, it should be removed. If the tooth fragment is irretrievable through the socket, it should be

retrieved through a Caldwell-Luc approach ASAP. However, this should be performed only if the dental surgeon is well versed with the procedure, else, the patient should be referred to an oral and maxillofacial surgeon.

If a small communication is made with the maxillary sinus during extraction of a tooth, the best treatment is leave it alone and allow the blood clot to form.

Post-operative instructions to patient:

• Avoid nose blowing for 7 days

• Open mouth when sneezing

• Avoid vigorous rinsing

• Soft diet for 3 days

If a sinus communication should occur the following medications may be prescribed for one week:

1. local (nasal) decongestant

2. Antibiotics (Amoxicillin)

3. systemic decongestant

1. If the opening is of moderate size (2-6 mm), a figure of eight suture should be placed over the tooth socket.

2. If the opening is large (7 mm or larger), the opening should be closed with a flap procedure.

The integrity of the floor of the maxillary sinus is at greatest risk with surgery involving the removal of a single remaining maxillary molar. The fear here is possible ankylosis.

Ideal time to remove impacted third molars:

# The ideal time to remove impacted third molars is:
A. When the root is fully formed
B. When the root is approximately two-thirds formed
C. Makes no difference how much of the root is formed
D. When the root is approximately one-third formed

The correct answer is B. When the root is approximately two thirds formed.

• Patient would be around the age of 17-21.
• At this time, the bone is more flexible and the roots are not formed well enough to have developed curves and rarely fracture during extraction.
• When the root is fully formed, the possibility increases for abnormal root morphology and for fracture of the root tips during extraction.