Root banking is not a very common procedure when treating patients that have lost an anterior tooth. In a really esthetically-concerned patient, it’s a great treatment option as long as the patient has a biologically healthy root and they don’t have any periodontal problems. Below are a few steps to help guide you through a successful root banking procedure.

Step 1: Fill canal with resin-modified glass ionomer cement. You’ll need to clean up where the post was located and make sure the area is free of caries before filling the endodontic portion with the glass ionomer cement.

Step 2: Reduce tooth structure. With a burr, prep the tooth until it’s .5mm below bone. It may be helpful to probe to the bone and look at where the tooth is positioned relative to where the bone is. You can then prep the inside of the tooth and thin the walls out allowing you to chip away parts of the tooth as opposed to grinding down the teeth and gingiva.

Step 3: Make provisional. The provisional needs to have the contours and the emergence profile interproximally. It’s critical to leave 2mm of space between the pontic and the remaining root to maintain optimal tissue health and esthetics.

The great thing about this uncommon procedure is that you and your patient won’t ever have to worry about the tissue migrating. Since there is still a root maintaining the bone, that tissue isn’t going anywhere.

Comments

Commenter's Profile Image L Winter
August 24th, 2012
Good description Mark. It might be more helpful to less experienced dentists to know if this is always a flapless procedure and to see post op photos
Commenter's Profile Image Steve Cook
August 25th, 2012
Mark, can you elaborate on how the provisional is secured? I'm guessing it's bonded to adjacent teeth.
Commenter's Profile Image Mark J Fleming DDS
August 26th, 2012
Either bonding to adjacent teeth or using Essex type retainer.
Commenter's Profile Image Adrian Bai
September 3rd, 2012
Thanks Mark. I have a situation where the lower incisor and canine seems like a good candidate to root bank. Instead of provisionalising, we intend to let the soft tissues grow over so that a denture can be made. would it be better to remove tooth structure to 1 or 1.5mm apical to the bone crest?
Commenter's Profile Image Michael Galloway
June 11th, 2013
What procedure code is used to report root banking?