Extraction (XAP) of #36, #37 and Retained Root #38 Removal
Surgical Removal
Retained Root
Chief Complaint
Patient complains of swelling, pain, and gingival bleeding on the lower left posterior teeth.
Clinical Findings
Tooth #37: Deep distal probing depth with severe bleeding on probing; very tender to palpation (TTP); potentially impacted tooth #38 at the distal of #37.
Tooth #36: Mesial deep probing depth extending to the apices; very TTP.
Treatment Plan
Advised panoramic radiograph (OPG) to investigate the condition.
Patient agreed to the OPG.
Pre-operative Assessment
OPG taken, revealing:
Tooth #36: Mesial root bone loss due to periodontitis extending to the mesial root apex; periodontally-endodontically involved, deemed a hopeless tooth.
Tooth #37: Distal bone loss extending to the apex of the distal root; periodontally-endodontically involved, deemed a hopeless tooth.
Tooth #38: Retained roots noted; patient removed the tooth long ago in a hospital but was not informed of the retained roots.
Anesthesia
Local anesthesia (LA) administered for extraction (XAP) of #36 and #37. The exact location of #38 could not be pinpointed, and access was limited.
Surgical Procedure
Advised local anesthesia and operative removal of retained roots of #38. The patient agreed to the procedure.
Pre-operative cone-beam computed tomography (CBCT) taken to ascertain the site of #38 retained roots.
The patient was cleaned and draped.
Incision made, buccal and lingual flaps raised.
Bone guttering performed to expose retained #38.
Tooth #38 elevated out in two pieces.
Curettage and irrigation with saline performed.
Post Operation Gallery
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Post-operative Assessment
OPG taken, revealing:
Tooth #36: Mesial root bone loss due to periodontitis extending to the mesial root apex; periodontally-endodontically involved, deemed a hopeless tooth.
Tooth #37: Distal bone loss extending to the apex of the distal root; periodontally-endodontically involved, deemed a hopeless tooth.
Tooth #38: Retained roots noted; patient removed the tooth long ago in a hospital but was not informed of the retained roots.