Surgical Removal of Retained Root and Carious Tooth #25 & #27
Surgical Removal
Chief Complaint
Patient presented with history of pain and swelling around upper left posterior region.
Clinical Findings
Tooth #27: Gross caries extending to pulp (based on prior OPG).
Tooth #27: Very tender to percussion (TTP, TTPp).
Slight metallic percussion tone — possible dense bone or ankylosis.
Tooth #25: Retained root with previous pus exudate, now resolved after medication.
OPG showed very radio-opaque bone and generally long roots.
Mobility and probing depth within normal limits.
Treatment Plan
LA XAP #27 (KIV Operative removal if required).
LA Operative removal of #25 retained root.
Risks, benefits, and procedures explained.
Patient understood and agreed to proceed.
Informed consent taken.
Pre-operative Assessment
OPG reviewed; CBCT planned for better root visualization.
Bone density and root proximity to sinus noted.
Swelling resolved post-medication.
Medical history non-contributory.
Anesthesia
Local infiltration administered for #25 and #27 regions.
Surgical Procedure
Patient cleaned and draped under aseptic protocol.
LA XAP performed for #27; coronal fracture occurred.
Due to very dense and sclerotic bone, tooth elevation was difficult.
CBCT taken intraoperatively to locate retained roots.
Buccal flap raised and bone guttering performed.
Sectioning of #25 and #27 roots done; teeth removed in 10 fragments.
Curettage and saline irrigation performed.
Due to bone density, tooth structure removed with additional reversed hammering and chiseling.
Maxillary sinus checked and found intact.
Wound closed with 4/0 BSS × 6 sutures for secondary closure.
Hemostasis achieved; postoperative instructions given.
Post-operative Assessment
Post-op CBCT confirmed no retained root fragments.
Adjacent teeth unaffected.
Sinus intact, no perforation.
Patient reassured and reviewed.