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Retained Root Near IAN — ORE Part 1 MCQ

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ModerateOral SurgeryRetained Root Near IANORE Part 1

During surgical removal of a lower third molar, the crown is removed but the distal root fractures. The fragment is vital, has no associated infection or pathology, and cannot be mobilised with gentle elevation. A radiograph shows the root apex in direct contact with the inferior alveolar canal. What is the most appropriate management?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: C — Leave the root in situ, explain the finding, document it, and arrange review

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

A is correct. An immobile, vital root fragment directly related to the inferior alveolar canal should not be pursued when removal is likely to injure the nerve. UK FDS guidance describes intentional root retention (coronectomy) as a nerve-sparing approach in which roots are left in situ to minimise inferior alveolar nerve morbidity. The same risk-management principle applies when a root fractures intraoperatively: stop further traumatic retrieval, explain the retained fragment and its potential sequelae, document the discussion, and arrange appropriate review. B, C and D all increase apical manipulation or bone removal adjacent to the canal and therefore increase the risk of paraesthesia. E does not remove the anatomical hazard; a change to general anaesthesia alone does not justify immediate re-operation in an asymptomatic case.

Reference: Faculty of Dental Surgery, Royal College of Surgeons of England. Parameters of care for patients undergoing mandibular third molar surgery, 2021: sections on coronectomy and surgical techniques. https://www.rcseng.ac.uk/-/media/Files/RCS/FDS/Guidelines/3rd-molar-guidelines--April-2021-v4.pdf