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Abandoned Extraction Referral — ORE Part 1 MCQ

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ModerateOral SurgeryAbandoned Extraction ReferralORE Part 1

During attempted extraction of a lower third molar under local anaesthesia, the crown fractures and the roots remain in situ. A post-extraction radiograph confirms that the retained roots are below the alveolar crest. The patient is comfortable and there is no uncontrolled bleeding, swelling, or evidence of infection. After 45 minutes, you judge that further removal would require a surgical approach beyond your competence. What is the most appropriate action?

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

Reveal the answer and explanation

Correct answer: E — Inform the patient, achieve haemostasis, close the socket, and arrange a routine oral-surgery referral with the radiograph

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

A is correct. This is a failed extraction in which further removal would require surgery beyond the operator’s competence. The appropriate immediate management is to stop, achieve haemostasis, close the wound as appropriate, explain the complication and plan to the patient, document it, and make a routine oral-surgery referral with the post-extraction radiograph and details of the attempt. UK referral guidance specifically lists failed extraction, supported by a post-extraction radiograph, as an indication for referral. Antibiotics are not indicated solely because roots have been retained in an asymptomatic patient. B risks disproportionate trauma and complications. C breaches the duty of candour and informed decision-making. D is unjustified without an acute complication such as uncontrolled haemorrhage, spreading infection, airway risk, or other emergency. E is unsafe and fails basic postoperative care.

Reference: NHS England, Department of Oral & Maxillofacial Surgery Referral Guidelines, 2015: failed extractions require an explanation and post-extraction radiograph; retained-root referral is appropriate where previous attempts have failed. https://www.england.nhs.uk/wp-content/uploads/sites/5/2016/08/dbh-nhs-ft-omsf-referal-guide.pdf