Retained root removal of tooth #47 and impacted #48
Surgical Removal
Impacted Wisdom Tooth, Retained Root
Chief Complaint
Patient reports pain in the fourth quadrant.
Clinical Findings
Tooth #46: Caries (distal occlusal), non-tender to palpation/percussion, mobility and probing depth within normal limits.
Tooth #47: Gross subgingival caries to pulp, very tender to palpation, non-tender to percussion, mobility and probing depth within normal limits. Negative bite test. Metallic sound on percussion. Prolonged deep severe dull aching on cold stimuli.
Treatment Plan
Option 1:
Root Canal Therapy (RCT) → Post and Core (PC) → Crown for #47.
Cap for #46 (do).
Option 2:
Extraction (XAP) of #47 (with possible oral surgery).
Cap for #46 (do).
Patient Decision: Chose Option 2.
Pre-operative Assessment
Local anesthesia for extraction of #47.
Encountered very dense bone and small mouth opening with strong buccal cheek musculature, making access difficult.
OPG Findings: Distal tight contact of #47 with buried distally impacted #48.
Revised Plan:
Attempt extraction of #47; if complications arise, proceed with oral surgery for #47.
Patient decided to remove #48 after viewing OPG.
Advised to leave #48 in situ unless symptoms appear if extraction of #47 is successful.
Further Procedure:
Attempted further elevation of #47, leading to coronal fracture.
Decided on oral surgery for removal of #47 and #48.
CBCT taken.
Patient requested removal of both #47 and #48.
Anesthesia
Local anesthesia block (right IDN, LN, and LBN).
Patient cleaned and draped.
Incision made, buccal flap raised.
Surgical Procedure
Bone guttering performed (very dense bone).
Tooth sectioning with difficult access.
#47 elevated out in 6 pieces.
#48 elevated out in 4 pieces.
Curettage and irrigation with saline.
BSS x 09 placed for primary closure.
Haemostasis achieved, post-operative instructions (POI) given.
Post Operation Gallery
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Post-operative Assessment
Local anesthesia for extraction of #47.
Encountered very dense bone and small mouth opening with strong buccal cheek musculature, making access difficult.
OPG Findings: Distal tight contact of #47 with buried distally impacted #48.
Revised Plan:
Attempt extraction of #47; if complications arise, proceed with oral surgery for #47.
Patient decided to remove #48 after viewing OPG.
Advised to leave #48 in situ unless symptoms appear if extraction of #47 is successful.
Further Procedure:
Attempted further elevation of #47, leading to coronal fracture.
Decided on oral surgery for removal of #47 and #48.
CBCT taken.
Patient requested removal of both #47 and #48.