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British Journal of Oral and Maxillofacial Surgery 46 (2008) 421

Technical note
Removal of a fractured palatal root
B. Krishnan 1
Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Al - Arab Medical Sciences University, Benghazi, Libya

Accepted 21 November 2007

Available online 3 January 2008

Keywords: Exodontia; Root removal

One of the most distressing complications during the removal

of a maxillary posterior tooth is the inadvertent displacement
of the root into the maxillary sinus. The offending tooth is
usually the palatal root of the first or second molar.1 Place-
ment of a bayonet forceps to remove this palatal root may be
difficult because of the thickness of the inter-radicular bone
between the buccal and palatal roots.
Textbooks usually recommend that when a large portion
of the palatal root is to be removed a small straight elevator
should be used as a wedge, or shoehorn, to displace the tooth
in an occlusal direction, care being taken to apply pressure in
gentle wiggling movements.2 The root often gets displaced
into the antrum because of the injudicious use of the dental
elevator. Failure to remove the root with an elevator neces- Fig. 1. Reamer with root.
sitates the removal of the thick inter-radicular bone using a
bur and handpiece under copious saline irrigation. The root Failure to deliver the root after a few attempts will make
may then be removed by placement of an appropriate eleva- formal removal unavoidable.
tor or forceps. This method is, however, time- consuming and
requires the help of an assistant. The use of a dental drill to
remove the root has also been described.3 Acknowledgement
A simple alternative can be the use of a barbed broach or
a Number 40 or 50 endodontic reamer. Under good lighting I thank Prof Mohan Alexander, MDS, MOMSRCPS (Glasg)
and vision the reamer can be wedged tightly into the remain- for his help.
ing pulp chamber with one or two clockwise turns, and then
removed with a sudden jerk. The palatal root is often deliv-
ered attached to the reamer (Fig. 1). However, care must be References
taken not to use excessive force in an apical direction. To
prevent the reamer from accidentally slipping into the oral 1. Howe G. The extraction of teeth. 2nd ed. London: John Wright; 1970. pp.
cavity or throat, a length of dental floss should be tied to it. 74–5.
2. Peterson LJ. Principles of complicated exodontia. In: Peterson LJ, Ellis
E, Hupp JR, Tucker MR, editors. Contemporary oral and maxillofacial
surgery. 4th ed. St Louis: Mosby; 2003, 179–80.
3. Meyer RE. Removal of roots. In: Waite DE, editor. Textbook of practical
E-mail address: krishident@yahoo.co.uk.
1 oral and maxillofacial surgery. 3rd ed. Philadelphia: Lea and Febiger;
74, 4th cross, Thanthai Periyar Nagar, Ellaipillaichavady, Pondicherry
1987. pp. 151–2.
605005, India.

0266-4356/$ – see front matter © 2007 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
doi:10.1016/j.bjoms.2007.11.010