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Roots-Submergence Under Roots-Submergence Under DenturesDentures

ContentsContents

Bone resorptionBone resorption Advantages of root submergenceAdvantages of root submergence Selection of tooth for submergenceSelection of tooth for submergence Methods of root submergence procedureMethods of root submergence procedure Steps of root submergence procedureSteps of root submergence procedure Problems of root submergence procedureProblems of root submergence procedure

Alveolar bone resorptionAlveolar bone resorption

Each jaw is divided into 2 areasEach jaw is divided into 2 areas

1- Basal bone: Which is that portion of the 1- Basal bone: Which is that portion of the mandible or maxilla that remains relatively mandible or maxilla that remains relatively stable regardless teeth are present or stable regardless teeth are present or absent in the arch, unless it is destroyed absent in the arch, unless it is destroyed by some pathologic lesions.by some pathologic lesions.

2- Alveolar process: Which forms and 2- Alveolar process: Which forms and supports the teeth sockets. It consists of the supports the teeth sockets. It consists of the alveolar bone proper, facial and lingual alveolar bone proper, facial and lingual plates. It is never in a static state.plates. It is never in a static state.

Factors affecting bone resorption:Factors affecting bone resorption:

- Anatomic factors:- Anatomic factors: Include the size, shape Include the size, shape and density of the ridges, the thickness and density of the ridges, the thickness of the mucosal covering, the ridge of the mucosal covering, the ridge relationship and the number and the relationship and the number and the depth of the sockets.depth of the sockets.

- Metabolic factors:- Metabolic factors: Include nutritional, Include nutritional, hormonal and other metabolic factors hormonal and other metabolic factors which affect the bone.which affect the bone.

- Functional factors:- Functional factors: Include the frequency, Include the frequency, intensityintensity, , direction anddirection and duration of the force duration of the force applied to the bone.applied to the bone. - Prosthetic factors: - Prosthetic factors: Include Include 1- The occlusal form of the teeth 1- The occlusal form of the teeth 2- Denture base material 2- Denture base material 3- V D 3- V D

Root submergence procedure:Root submergence procedure:In situation where the conventional In situation where the conventional overdenture approach is not available overdenture approach is not available (poor oral hygiene, periodontitis, caries (poor oral hygiene, periodontitis, caries and economics) the root submergence and economics) the root submergence procedures may be indicatedprocedures may be indicated

The procedure of retaining roots as a The procedure of retaining roots as a means of preventing resorpation of the means of preventing resorpation of the ridge is called ridge is called root submergenceroot submergence. The . The root of the tooth is cut to 2mm below the root of the tooth is cut to 2mm below the level of the alveolar bone and covered level of the alveolar bone and covered completely with gingival tissue flap.completely with gingival tissue flap.

Advantages of root submergence: Advantages of root submergence:

1)1) Preservation of alveolar ridgePreservation of alveolar ridge

2)2) Increased denture stabilityIncreased denture stability

3)3) Preservation of proprioceptive responses Preservation of proprioceptive responses

4)4) Inexpensive procedureInexpensive procedure

5)5) No need for special home careNo need for special home care

Selection of teeth for submergenceSelection of teeth for submergenceThe selected teeth must have the followingThe selected teeth must have the following

No more than 1mm horizontal mobilityNo more than 1mm horizontal mobilityNo pathological lesionsNo pathological lesionsSufficient healthy mucogingival tissueSufficient healthy mucogingival tissueSupporting alveolar bone equal to Supporting alveolar bone equal to approximately one third of the length of the approximately one third of the length of the root lengthroot lengthThe teeth must have a small occlusal tableThe teeth must have a small occlusal tableAdjacent teeth should not be presentAdjacent teeth should not be present

Mandibular premolars and canines are the Mandibular premolars and canines are the best teeth for submergence because:best teeth for submergence because:

1- The mandibular teeth are more important 1- The mandibular teeth are more important because of the difficulty in stabilizing of the because of the difficulty in stabilizing of the lower denture.lower denture.2- Canines and premolars provide the most 2- Canines and premolars provide the most suitable position in the arch.suitable position in the arch.3- There is a greater concentration of 3- There is a greater concentration of sensory receptors in the ligaments of these sensory receptors in the ligaments of these teeth.teeth.

4- The root canal treatment is a simple in 4- The root canal treatment is a simple in these teeth.these teeth.5- Canine is the last tooth to be lost.5- Canine is the last tooth to be lost.6- Canine has an adequate root dimension.6- Canine has an adequate root dimension.

Methods of root submergence Methods of root submergence procedure:procedure:

a)a) Preservation of the Preservation of the vitality of the pulpvitality of the pulp in in the residual rootthe residual root

b)b) Endodontic treatmentEndodontic treatment of the residual root of the residual rootc)c) Endodontic treatmentEndodontic treatment of the root which of the root which

is intentionally extracted and then is intentionally extracted and then replantedreplanted and submerged and submerged

d)d) PulpectomyPulpectomy is performed in the residual is performed in the residual root and submerged without root canal root and submerged without root canal therapy therapy

Steps of root submergence Steps of root submergence proceduresproceduresA- Surgical procedure:A- Surgical procedure:

A wide mucoperiosteal flap was A wide mucoperiosteal flap was reflected labially, or bucally and reflected labially, or bucally and lingually allowing adequate exposure of lingually allowing adequate exposure of the alveolous.the alveolous.The selected tooth was transacted by The selected tooth was transacted by the use of appropriate burs in a high the use of appropriate burs in a high speed hand piece using a water speed hand piece using a water coolant. The root was reduced 2mm coolant. The root was reduced 2mm below the crest of the bone.below the crest of the bone.

Closure was affected by a continuous Closure was affected by a continuous horizontal mattress suture to ensure version horizontal mattress suture to ensure version of the edge. of the edge.

V RE T R

Mattress suture

B- Prosthetic procedure: B- Prosthetic procedure:

Conventional complete dentures were Conventional complete dentures were constructed after 6 weeks from surgical constructed after 6 weeks from surgical operation.operation.

N B: P I P was used at the insertion N B: P I P was used at the insertion appointment to detect pressure areas. These appointment to detect pressure areas. These areas were relieved as indicated.areas were relieved as indicated.

Submerged roots after 9 months

Problems of root submergence Problems of root submergence procedureprocedure

Surgical factors:Surgical factors:a)a) In sufficient reduction in root heightIn sufficient reduction in root height

b)b) Improper contouring of the retained rootImproper contouring of the retained root

c)c) Insufficient tissue for perfect closureInsufficient tissue for perfect closure

Prosthetic factors:Prosthetic factors:

a)a) Abnormal denture pressure from ill Abnormal denture pressure from ill fitted denture basefitted denture baseb)b) Inadequate balanced denture Inadequate balanced denture occlusionocclusion

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