Extraction of Tooth #37 with Retained Roots and Impacted #38
Surgical Removal
Embedded and impacted
Chief Complaint
Patient reported smelly tooth #37 and swollen gingiva around the tooth.
Clinical Findings
Tooth #37: Bone loss, swollen gingiva, increased probing depth (4 ↔ 6mm), recurrent subgingival marginal caries, slight tenderness to percussion, mobility and probing depth within normal limits, possible ankylosis.
Tooth #38: Embedded and impacted.
Treatment Plan
Extraction (XAP) of tooth #37, possibly requiring an operative procedure (OP) if complications arise.
Removal of impacted tooth #38 due to its potential interference with future implant placement for tooth #37.
Pre-operative Assessment
Pre-operative CBCT taken.
Inferior Dental Nerve (IDN) plotted.
Risks of paraesthesia to the lower lip and tongue, and oro-antral perforation (OAP) or oro-antral fistula (OAF) explained to the patient.
Procedures thoroughly explained.
Patient understood and agreed to proceed.
Informed consent obtained.
Anesthesia
Right IDN, LN, and LBN blocks administered.
Surgical Procedure
Preparation:
Patient cleaned and draped.
Buccal flap raised with an incision.
Extraction of #37:
Initial attempt for LA XAP resulted in coronal fracture.
Retained roots and subgingival caries noted.
Unable to extract #37 normally; OP removal advised.
Bone grafting performed.
Tooth sectioned and elevated out in three pieces.
Removal of #38:
Further bone guttering to expose #38.
Tooth sectioned.
Mid-OP CBCT taken to navigate retained root tips.
Retained roots removed, elevated out in 15 pieces.
Curettage and irrigation with saline.
Bone grafting performed using EthOss and Dentium Osteon II Collagen materials.
Flap released.
BSS (Balanced Salt Solution) placed for primary closure.
Achieved haemostasis.
Post-operative instructions (POI) given.
Post Operation Gallery
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Post-operative Assessment
Pre-operative CBCT taken.
Inferior Dental Nerve (IDN) plotted.
Risks of paraesthesia to the lower lip and tongue, and oro-antral perforation (OAP) or oro-antral fistula (OAF) explained to the patient.
Procedures thoroughly explained.
Patient understood and agreed to proceed.
Informed consent obtained.