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Roots-Submergence Under Dentures

Bone resorption

Advantages of root submergence

Selection of tooth for submergence

Methods of root submergence procedure

Steps of root submergence procedure Problems of root submergence procedure

Alveolar bone resorption

Each jaw is divided into 2 areas 1- Basal bone: Which is that portion of the mandible or maxilla that remains relatively stable regardless teeth are present or absent in the arch, unless it is destroyed by some pathologic lesions.

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

Factors affecting bone resorption:

- Anatomic factors: Include the size, shape and density of the ridges, the thickness of the mucosal covering, the ridge relationship and the number and the depth of the sockets. - Metabolic factors: Include nutritional, hormonal and other metabolic factors which affect the bone.

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

Root submergence procedure:

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

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

Advantages of root submergence:

1) Preservation of alveolar ridge

2) Increased denture stability

3) Preservation of proprioceptive responses

4) Inexpensive procedure
5) No need for special home care

Selection of teeth for submergence

The selected teeth must have the following No more than 1mm horizontal mobility No pathological lesions Sufficient healthy mucogingival tissue Supporting alveolar bone equal to approximately one third of the length of the root length The teeth must have a small occlusal table Adjacent teeth should not be present

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

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

Methods of root submergence procedure:

a) Preservation of the vitality of the pulp in

the residual root b) Endodontic treatment of the residual root c) Endodontic treatment of the root which is intentionally extracted and then replanted and submerged d) Pulpectomy is performed in the residual root and submerged without root canal therapy

Steps of root submergence procedures

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

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


Mattress suture

B- Prosthetic procedure: Conventional complete dentures were constructed after 6 weeks from surgical operation. N B: P I P was used at the insertion appointment to detect pressure areas. These areas were relieved as indicated.

Submerged roots after 9 months

Problems of root submergence procedure

Surgical factors:
a) b) c)

In sufficient reduction in root height Improper contouring of the retained root Insufficient tissue for perfect closure

Prosthetic factors:
a) Abnormal denture pressure from ill fitted denture base b) Inadequate balanced denture occlusion