Surgical Removal of Retained Root at #24
Surgical Removal
Chief Complaint
Patient presented with pain and discomfort at upper left premolar region (#24).
Clinical Findings
#24 grossly carious with caries extending to pulp
Tooth very tender to percussion and palpation
Buccal sinus tract present
Mobility and probing depths within normal limits
Slight metallic sound on percussion suggesting possible ankylosis
CBCT:
Extensive caries involving buccal and lingual walls
Retained root fragments
Severe buccal bone loss
Periapical lesion associated with #24
Root morphology: long, wide, flattened root
Close proximity to maxillary sinus
Overall sound surrounding bone level
Treatment Plan
LA surgical removal of retained roots at #24
Discussed option of immediate implant placement with temporary crown; patient elected removal only at this visit
Pre-operative Assessment
Informed consent obtained
Risks, benefits, alternatives explained
Pre-operative CBCT taken to evaluate anatomy and confirm bone and sinus proximity
Anesthesia
Local anesthesia administered
Surgical Procedure
Patient cleaned and draped
Incision made, buccal flap raised
Bone guttering performed for access
Tooth/root sectioned
Retained roots removed in two pieces
Thorough curettage of socket
Irrigation with sterile saline
BSS x3 placed to support secondary closure
Hemostasis achieved
Post-operative Assessment
Post-op CBCT confirmed no remnants
Sinus and adjacent teeth unaffected
Post-operative instructions provided