The removal of a primary tooth anterior abutment root to salvage a fixed prosthesis

Removal of one or more affected roots in a multi-rooted molar can play a role in prosthetic treatment. This procedure can help to retain a part of a molar as an abutment for fixed prosthesis or support a cantilever fixed prosthesis or overdentures. Retaining a portion of distalmost molar as a valuable terminal abutment may avoid distal extension with the associated drawbacks.1^,2 Unlike molars, root removal is not generally employed in anterior abutments as they are single-rooted. This case presentation illustrates root removal in a failing anterior abutment to salvage a fixed prosthesis, which is rarely reported in the literature.

A 52-year-old woman patient was presented with a chief complaint of pain and swelling in the mandibular left anterior region. Clinical examination revealed a mandibular anterior fixed prosthesis extending from LR3 to LL3. An intra-oral apical swelling with a sinus opening and a deep periodontal pocket extending to the apical region of LR2 was noted (Figure 1). Radiographic examination showed that LR2 and LR3 served as non-endodontically treated primary and secondary abutments, respectively, on the right side of the prosthesis. However, LR2 showed severe periodontal bone loss with a periapical radiolucency (Figure 2). The sinus was traced and a radiograph confirmed its origin from LR2. Radiographic appearance in LR2 also resembled changes indicative of either an anatomical variation or vertical root fracture in the tooth. Removal of LR2 was suggested due to the poor periodontal prognosis, but it required the removal of the prosthesis. The patient did not wish the removal of the prosthesis to take place as she was averse to the risks involved in terms of damage to the abutments and the prosthesis itself during the removal. However, since LR3 as a secondary abutment and LL3 as a primary abutment were stable on the right and left sides of the prosthesis, respectively, sectioning and removal of LR2 root was suggested as an alternative solution to eliminate the source of infection, though LR2 was a primary abutment. This was suggested to avoid the removal of the prosthesis and salvage the prosthesis to continue its functioning in the existing condition. The patient was in agreement.