Extraction and Ridge Preservation Bone Grafting for Endodontic-Periodontal Involved Upper First Molar (#16)
Surgical Procedure
Chief Complaint
Patient presented with pain affecting the upper right posterior region and reported swelling on both the buccal and palatal aspects of tooth #16.
Clinical Findings
Tooth #16
Tender to percussion.
No tenderness to palpation.
Normal mobility.
Deep periodontal probing extending to the root apices on the buccal aspect.
Negative bite test.
Negative transillumination test.
Large buccal restoration extending into the furcation.
CBCT demonstrated periapical lesions involving the mesiobuccal, distobuccal, and palatal roots.
Diagnosis: Combined endodontic-periodontal lesion with poor restorative prognosis.
Treatment Plan
Extraction of non-restorable tooth #16.
Thorough debridement of infected tissues.
Ridge preservation bone grafting to maintain the extraction site for future treatment options.
Standard post-operative review and care instructions.
Pre-operative Assessment
CBCT imaging was reviewed to assess the extent of infection and surrounding bone loss.
The patient was informed of:
The poor prognosis of tooth #16.
The extraction procedure.
Bone grafting to preserve the extraction socket.
Risks, benefits, expected healing, and possible complications.
The patient understood the treatment plan and provided informed consent.
Anesthesia
Local anaesthesia administered to the surgical site.
Surgical Procedure
The patient was cleaned and draped under sterile protocol.
Tooth #16 extracted under local anaesthesia.
Purulent infection drained.
Extraction socket thoroughly curetted.
Granulation tissue completely removed.
Buccal and palatal flaps elevated and released.
Ridge preservation bone grafting performed using Dentium Osteon II Collagen synthetic bone graft material.
Six interrupted sutures placed to achieve closure.
Haemostasis confirmed.
Post-operative Assessment
Extraction completed successfully.
Infected tissue thoroughly debrided.
Bone graft placed to preserve the extraction socket.
Surgical site achieved satisfactory haemostasis.
Post-operative instructions provided.