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8 weeks ago (edited)
LOST ROOT TIP
To piggyback on the theme of @RYAN ‘s WTF Wednesday post... Take a look at this little complication.
I extracted #14 by sectioning it, however a little piece of root tip fractured off of the palatal root. I considered leaving it, but figured I would try one last time with the root tip pick. As I reached for the root tip and gave it one little tug, it completely VANISHED!
Then there was nothing.
Hoping that somehow I was wrong and that it was not in there, I took a pano just to be sure. Sure enough it’s in the sinus. Can you find it?
I referred him right away to the local oral surgeon’s office to discuss options of retrieving it or leaving it alone. They firmly replied they would not be able to see him for 1 month.
Well, I prescribed 1 week of Augmentin, and we waited for one month. The oral surgeon saw him and promptly became pissed off with me for not sending the patient in sooner. He called the office (not my office, mind you. An office where I travel to place implants) and started yelling at the owner and making disparaging comments about me.
Anyway, yesterday I saw the patient again. He had chosen to leave the root tip alone as he has no symptoms. I placed an implant at #14.
Patient is a retired orthopedic surgeon to boot!
Would you have done anything differently? Has this happened to anyone?
What should we do about the root tip?
Jedediah and dtberat_dds6 Comments-
WTF is right!
Sounds like it’s time to find a new OS to refer to.. that’s ridiculous how they handled it
Is a root tip in the sinus usually handled like a tooth displaced into the infratemporal fossa? Let it fibrose? Or do they usually like to go after them in the sinus right away?
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I am not a fan of leaving root tips behind so I’m sure I would’ve done the same and ended up in the same boat!
I would have called another OS to get the patient in right away though. If the OS isn’t available same day for cases like this.. then they won’t be getting my referrals anymore.
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It’s unfortunate your referral was handed in that way. The whole reason why we have a referral system in dentistry is because no one can be an expert of everything. And you have to be humble enough matter what you’re training is to know that.
The decision to remove the root tip by a caldwell luc or lay window procedure determined by if there’s pathology associated with a root tip or not. I once worked with OMFS. He really didn’t care if they were little non-path root tips in the sinus.
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If the patient is old, then let it be and keep checking every 5-6 months to see if there will be any changes in the lower sinus walls surrounding the tip. The moment a patient feels discomfort, sinus swelling, green/yellow nasal discharge, fever, reoccurring headaches – time to worry and get a control cbct to check and probably only then go in to extract. Otherwise just turn the grill on, invite the patient for a steak and have a few beers while talking crap about some referral surgeons 🤣🤣🤣
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I would have asked to speak to the surgeon one on one. so many front desk people are new and don’t understand appropriate protocol. You get one erroneous conversation with the “wrong” person and you’re in a **it-storm of a potential liability.
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@shingst This is a great suggestion. I will definitely be doing this next time.
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