Displacement of Root Fragment — ORE Part 1 MCQ

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ModerateOral SurgeryDisplacement of Root FragmentORE Part 1

A dentist is removing a lower right third molar and inadvertently displaces the root tip into the submandibular space. What is the most appropriate action?

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Correct answer: B — Stop the procedure and refer to oral and maxillofacial surgery

Explanation lettering: B = shown as A · A = shown as B · E = shown as C · C = shown as E

Answer: A. Submandibular displacement of a root fragment requires immediate referral to oral and maxillofacial surgery. The displacement into a deep fascial space is beyond the scope of general dental practice—it necessitates computed tomography for precise localisation, general anaesthesia, and a specialist lingual flap approach to prevent permanent nerve damage and infection. Attempting retrieval through the socket (B) risks blind dissection into vital structures. Direct lingual extension by a general dentist (C) without specialist training and GA provision risks catastrophic lingual nerve injury and airway compromise. Leaving the fragment with antibiotics alone (D) permits chronic infection, pain and delayed, more difficult retrieval. Obtaining CT in primary care (E) delays essential specialist intervention. Early referral ensures timely control of infection and nerve injury prevention.

Reference: NHS England Oral Surgery Clinical Standard (2024); Inferior Alveolar Nerve Impairment Following Third-Molar Extraction: Management of Complications (NCBI PMC, 2024); Submandibular displacement of a mandibular third molar root during extraction: case report (NCBI PMC, 2010). https://www.england.nhs.uk/long-read/oral-surgery-clinical-standard/ and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11989344/