Retained Root Removal for Tooth #18
Surgical Removal
Retained Root
Chief Complaint
Patient complains of pain in the 4th quadrant, with pain noted around the swollen buccal cheek and #48 operculum.
Clinical Findings
Pain and swelling noted in the buccal cheek.
#18 traumatic occlusion with operculum and abrasion with buccal cheek.
Orthopantomogram (OPG) shows #38 distal bony impaction and #48 partially erupted.
Treatment Plan
Extraction of #18, possible operative procedure if complications arise.
Antibiotics prescribed.
Extraction of #48, possible operative procedure if complications arise.
Pre-operative Assessment
OPG taken.
Risks and procedures explained to the patient.
Patient agrees to proceed.
Informed consent obtained.
Pre-operative CBCT taken for further assessment.
Anesthesia
Local anesthesia administered for extraction of #18.
Surgical Procedure
Extraction of #18 attempted, noting flared out roots and very thin roots.
Distobuccal (db) root fractured and retained.
Unable to access due to swollen buccal cheek, limited mouth opening, and #17 obstructing the path of access as #18 is more lingually placed than #17.
Advised and proceeded with LA operative removal of #18 (db) retained root.
Patient cleaned and draped.
Incision made, and buccal flap raised.
Bone guttering performed.
#18 (db) root elevated out using periotomes, root picks, and elevators.
Irrigated with saline.
Bone substitute sponge (BSS) x 03 placed for primary closure.
Hemostasis achieved and post-operative instructions given.
Post Operation Gallery
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Post-operative Assessment
OPG taken.
Risks and procedures explained to the patient.
Patient agrees to proceed.
Informed consent obtained.
Pre-operative CBCT taken for further assessment.