Guided Extraction?
I was working up a case referred by a colleague recently and part of the referral, in addition to an implant, was that the patient complained about a chronic dull ache ever since he'd had a tooth extracted a few years ago. A PA from the referring dentist demonstrated that there was a retained root:
Sidexis CBCT image demonstrated it this way:
As I was planning his implant for the number 5 position in Galaxis I was trying to decide what to do about this root tip when it hit me:
I figured there was an accessible path for an osteotomy that would allow access to the root tip, and if I couldn't deliver the fragment I could simply drill through it. I didn't much feel like cutting a huge hole in his palate and risking damaging the vital #3, so I designed a pair of CG2 guides and printed them.
After delivering the implant I accessed the root
I was unsuccessful trying to deliver the root tip intact, so I drilled through it, felt confident that it was obliterated, grafted and closed, and here's the postop:
After using this method for guided implant osteotomies for so many years so successfully, I had every confidence that I would be able to access the root tip and minimize the risk to the adjacent tooth. Guided root extractions.....I love what Sirona technology and a little out of the box thinking can do for our patients!
Very Nice work Jeremy....now that you have "done it" do you think next time you would try without the palatal flap incision for the root tip removal? Not sure if you felt you needed for some other reason?
I flapped it because I wanted primary closure over the osteotomy site and graft when I was done. I'm not sure I could have done that with a tissue punch access; is that what you're asking?
Thought I'd show you guys a followup here. This was the immediate post op situation:
And here was the 3 week follow up:
Farhad touched on this recently in his CTG webinar and it made me want to post this for those of you who get nervous about the prospect of palatal incisions; this patient had so little postop pain that he took zero analgesics or other pain meds with the exception of the preop ibuprofen that we gave him. His biggest complaint was the soft diet we recommended. Generally speaking, my patients have experienced little pain and no complications and I find that I have no anxiety about either harvesting CTG from the palate or making large palatal incisions like this.
Jeremy
Something I keep forgetting to add to this: I think you can use this technique for guided apicoectomies as well. I rarely do these, so maybe somebody who does can give it a try and document the process for us
Jeremy
Friggin awesome! I'm definitely putting this on my pocket for the future! I've wondered about this for apicoectomy... Might have to tinker with that a bit!
Jeremy,
Do you think I can fabricate a guide hole up alone the buccal ridge for this extraction? I love your process here and want to copy it for this retained root. 
Thanks,
Kirsten
I’m not sure Kirsten; plan it in galaxis like I did and see how it looks. I’d be worried about accuracy of the guide with all that metal in the anterior, and you’ll have to use such a long drill that will also affect the accuracy some. However, as you’re really only risking an Endo treated tooth next door, I don’t think anxiety should be too high, just elevated levels of caution.
