Retained Root Removal for #36

Chief Complaint

Failed root fillings with gross periapical lesions and sinus tract in teeth #26 and #36.

Tooth #17 site healing very well.
Failed root fillings in teeth #26 and #36 with gross periapical lesions and sinus tract.
CBCT review shows roots of #26 and #36 fused with buccal cortical bone, potentially ankylosed.

CBCT reviewed showing fused and potentially ankylosed roots for #26 and #36.
Patient advised of potential complications in local anesthesia outpatient (LAOP) removal due to ankylosis.
Patient understood and agreed to proceed with the extraction of #36 first.

Local anesthesia administered for the extraction of #36.

1. Patient cleaned and draped.

2. Buccal flap raised.

3. Bone guttering performed.

4. Tooth sectioning.

5. #36 crown dislodged and coronal portion fractured.

6. Unable to luxate #36 with forceps and elevators.

7. Advised for LAOP removal of retained #36 roots.

8. Risks and procedures explained; informed consent obtained.

9. Incision and buccal flap raised.

10. Bone guttering and tooth sectioning.

11. #36 elevated out in pieces.

12. Intra-OP CBCTs taken to locate broken tooth remnants.

13. Tooth kept chipping due to dense bone and previous RCTs.

14. #36 elevated out in 30 pieces excluding crown and porcelain chips.

15. Currettage and irrigation with saline.

16. Post-OP CBCT taken showing GP trace at the apical of the distal root; no other remnants noted.

17. Currettage and irrigation with saline.

18. BSS x 05 placed for primary closure.

19. Haemostasis achieved and post-operative instructions given.

CBCT reviewed showing fused and potentially ankylosed roots for #26 and #36.
Patient advised of potential complications in local anesthesia outpatient (LAOP) removal due to ankylosis.
Patient understood and agreed to proceed with the extraction of #36 first.