Oral Hygiene Instruction and Extraction of Tooth #26
Surgical Removal
Chief Complaint
The patient presented for oral hygiene instruction and reported issues with tooth #26.
Clinical Findings
Tooth brushing technique was advised and revised.
iO3 Oral-B electric toothbrush was introduced, and a demonstration was provided. CHX mouthwash was recommended.
Tooth #26:
Non-tender to percussion.
Metallic sound on percussion.
Very dense thick bone or possible ankylosis.
Mobility within normal limits.
Probing depth within normal limits.
Bite test negative.
Transillumination test positive.
A deep mesio-buccal to disto-palatal crack was noted after removal of calculus, plaque, and stains.
The crack extends beyond the crestal level on probing, indicating a hopeless prognosis.
Treatment Plan
Extraction of tooth #26 (XAP).
Potential need for LA OP removal of retained roots if coronal fracture occurs during extraction.
Pre-operative Assessment
The patient was informed about the hopeless prognosis of tooth #26. Pre-operative CBCT was taken.
The patient agreed to proceed with the extraction and was informed about the potential need for surgical removal of retained roots if a coronal fracture occurred.
Anesthesia
Local anesthesia block administered to the right inferior dental nerve (IDN), lingual nerve (LN), and long buccal nerve (LBN).
Surgical Procedure
Tooth #26 fractured coronally during forceps extraction, leaving firm retained roots.
LA OP removal of retained roots was required.
The patient was cleaned and draped.
An incision was made, and a buccal flap was raised. Bone guttering and tooth sectioning were performed.
Tooth #26 was elevated in 18 pieces.
BSS x 04 was placed for primary closure.
Haemostasis was achieved.
Post-operative Assessment
Post-operative CBCT was taken.
No tooth remnants were noted.
The maxillary sinus was intact and not involved in the surgery.
The patient was reassured.