Dental root elevator embedded into a subgingival caries: a case report

Abstract

Background: Breakage of surgical instruments is a rare complication. A mistake in operator technique or sub-standard/aged tools could lead to this type of accident. A tooth elevator is an instrument used in minor oral surgical procedures to luxate the tooth or fractured root from its socket. The authors have not found any previously published cases reporting the breakage of a tooth elevator tip which then remained as a foreign body in a hidden caries cavity.

Case presentation: A 28-year-old African black male was referred to a hospital in Tanzania for an intraoral radiography. The patient explained that six months previously his mandibular left third molar had been extracted. Whilst the healing process had been satisfactory, he had recently experienced acute oral pain in this region. The dental X-ray showed an image consistent with a piece of broken metal embedded in a distal subgingival caries at the mandibular left second molar.

Conclusion: Oral and dental surgeons should take particular care when employing metal instruments with strong force in poorly visible areas. A radiographic study should be carried out when instrument breakage occurs. If an unexpected accident takes place during a surgical procedure, the patient must be informed in accordance with ethical codes, and suitable measures adopted to resolve the issue.

Figure 1

Luxating dental elevators with curved bladed tips to facilitate root extraction.

Figure 2

Periapical radiographic image: Notice the curved blade elevator tip broken and embedded in a subgingival caries cavity of the mandibular left second molar (37). Observe two radiolucent apical lesions in the affected molar (37) and a slight radiopacity located on the distal part of the first molar crown (36), which was a consequence of the Kocher clamp used during a manual developing process.