A tooth broken at or just beneath the gum line (a subgingival fracture) presents a unique challenge for dental professionals. Standard extraction using forceps is impossible because minimal or no coronal structure remains to grip. Removing the root remnant requires a controlled surgical or semi-surgical approach designed to access the root while preserving the surrounding bone and gum tissue. This specialized process is necessary to safely eliminate the source of potential infection or pain and prepare the site for future tooth replacement.
Pre-Procedure Diagnosis and Anesthesia
Before removal, the dentist conducts a diagnostic assessment using detailed X-rays or a Cone-Beam Computed Tomography (CBCT) scan. These images visualize the root’s anatomy, including its length, curvature, and the condition of the surrounding bone. The dentist also notes the root’s proximity to nearby structures, such as the mandibular nerve or maxillary sinuses, to prevent complications.
Once the assessment is complete, local anesthesia (such as lidocaine or articaine) is administered to the surgical site. The injection numbs the gum tissue and surrounding bone structures. While the patient will feel pressure and movement, the anesthesia eliminates any sensation of pain, which is required for the meticulous work of removing the embedded root fragment.
Specialized Extraction Methods for Broken Roots
When a root is broken below the gum line, the dentist must gain surgical access. This begins with creating a small surgical flap, where the gum tissue is gently lifted using a scalpel and a periosteal elevator. This flap allows for direct visualization and controlled maneuvering of instruments to remove the root with minimal trauma to the socket.
Specialized instruments are used to separate the root from the jawbone. Thin, sharp luxators delicately cut the periodontal ligament fibers holding the root in place. Next, dental elevators (such as Apexo or Apical elevators) apply controlled leverage to gradually loosen the root fragment. This technique avoids excessive force that could damage the bone or cause further fragmentation.
Root Sectioning and Bone Removal
For multi-rooted teeth, such as molars, the dentist may perform root sectioning using a dental bur. This divides the remnant into smaller, manageable pieces, allowing for individual removal with less trauma. Occasionally, a minimal amount of surrounding bone must be carefully removed in a process called ostectomy. This creates a small “gutter” for instrument access, ensuring the root can be delivered intact while preserving maximum bone for future restoration.
Managing the Extraction Site After Removal
After the root is removed, the dentist prepares the socket for optimal healing. The site undergoes debridement, where a curette cleans the socket walls, removing residual debris, bone fragments, or infected soft tissue. This cleaning prevents infection and promotes the healthy formation of a blood clot.
The dentist often recommends socket preservation, placing bone graft material into the empty socket. This material (synthetic, bovine, or human-derived) prevents the natural collapse of the alveolar ridge following tooth removal. Preserving the jawbone’s height and width ensures a stable foundation for a future dental implant or prosthetic device.
Finally, the dentist achieves hemostasis (stopping the bleeding). If a surgical flap was used, the gum tissue is repositioned and secured with sutures. These stitches protect the graft material and the blood clot, and are typically removed or dissolved after about one week.
Recovery and Future Tooth Replacement Options
Initial recovery focuses on managing discomfort and encouraging a stable blood clot. Patients should keep their head elevated and limit physical activity for the first 24 to 48 hours to minimize swelling. Specific instructions include avoiding straws and smoking, as suction can dislodge the clot and cause dry socket.
Most patients resume non-strenuous activities within three days, though full bone remodeling takes several months. Pain is managed with anti-inflammatory medications, and gentle rinsing with warm salt water is recommended after the first day. Planning for long-term tooth replacement is the next crucial step.
Replacing the extracted tooth prevents adjacent teeth from shifting and maintains jawbone density. Common replacement options include:
- A dental implant, which involves surgically placing a titanium post into the healed jawbone to serve as a new root for a crown.
- A fixed bridge, which spans the gap by anchoring an artificial tooth to the natural teeth on either side.
- Removable partial dentures, which offer a less invasive and more affordable option to restore appearance and function.