Surgical Extraction and Retained Root Removal in the 2nd Quadrant
Surgical Removal
Chief Complaint
Patient reported pain in the 2nd quadrant.
Clinical Findings
Teeth #27 and #28: Very tender to percussion (TTP), not tender to palpation (NTTPp).
Mobility and probing depth within normal limits (WNL).
Metallic sound on percussion indicating very dense bone.
OPG taken.
Diagnosis: Caries to pulp in teeth #27 (distal) and #28 (mesial), pulpitis, very long roots.
Treatment Plan
Extraction of teeth #27 and #28.
Potential retained root removal of #27 if complications arise.
Pre-operative Assessment
Advised options included extraction and root canal treatment with crowning or extraction of both teeth.
Patient chose extraction of both teeth (#27 and #28).
Risks and procedures explained, patient understood and agreed to proceed.
Informed consent obtained.
Pre-operative CBCT taken.
Anesthesia
Local anesthesia administered for extraction of #27 and #28.
Surgical Procedure
Extraction of Teeth #27 and #28:
Noted very dense bone.
Cortical bone fractured and elevated out with teeth #27 and #28.
Distal root of #27 fractured, palatal root inaccessible.
2. Removal of Retained #27 Palatal Root:
Local anesthesia infiltration increased.
Patient cleaned and draped.
Incision made, buccal flap raised.
Bone guttering performed to access #27 palatal root.
Palatal root of #27 picked out using periotomes and root picks.
Curettage and irrigation with saline.
BSS x 04 placed for primary closure.
Achieved haemostasis and provided post-operative instructions (POI).
Post-operative Assessment
Post-operative CBCT taken.
Confirmed no involvement of the maxillary sinus, and complete removal of tooth remnants.
Patient reassured.