#46 Caries to Pulp
Surgical Removal
Chief Complaint
Patient reported significant tenderness to percussion and palpation in tooth #46.
Clinical Findings
Tooth #46 showed gross and extensive caries involving buccal and lingual walls.
Slight metallic sound on percussion suggested dense bone or possible ankylosis.
Mobility and probing depth were within normal limits.
Periapical (PA) radiograph revealed extensive caries reaching the pulp with sound bone level.
Treatment Plan
1) Recommended: Root canal treatment (RCT) followed by post and core (PC) and crown placement.
2) Alternative: Extraction of tooth #46, with potential for retained root removal if fracture occurs, followed by options for implant, bridge, denture, or leaving the space empty.
Patient chose the extraction option despite being informed of the complications associated with losing tooth #46.
Pre-operative Assessment
Pre-operative CBCT was taken.
Tooth #46 showed fractured retained roots with apical PA lesions.
The roots were long, wide, flattened, with thin, curved features and a bulbous root apex on the distal root, possibly indicating hyper-cementosis.
Anesthesia
Local anesthesia was administered via right inferior dental nerve (IDN), lingual nerve (LN), and long buccal nerve (LBN) blocks.
Surgical Procedure
1. Tooth #46 coronally fractured during gentle forceps extraction, leaving firm retained roots.
2. Buccal flap raised after making an incision.
3. Bone guttering and tooth sectioning performed.
4. Tooth #46 was elevated in 19 pieces.
5. Curettage and saline irrigation completed.
6. BSS x 04 placed for secondary closure.
7. Haemostasis achieved.
Post-operative Assessment
Post-operative CBCT confirmed that no remnants were left, and the inferior dental nerve (IDN) and adjacent teeth were not involved.