Surgical Removal for #27, #28
Surgical Removal
Retained Root, Extraction
Chief Complaint
Patient complains of pain in the 2nd quadrant.
Clinical Findings
Teeth #27 and #28: very tender to percussion, non-tender to palpation.
Mobility and probing depths within normal limits.
Metallic sound on percussion.
Very dense bone observed.
Caries in teeth #27 (distal) and #28 (mesial) extending to the pulp.
Pulpitis with very long roots.
Treatment Plan
Option 1:Extraction of tooth #28.
Root canal treatment for tooth #27 with post-core and crowning.
Possible surgery if extraction is complicated.
Option 2:Extraction of teeth #27 and #28.
Possible surgery if extraction is complicated.
Patient chose option 2.
Risks and procedures explained.
Patient understood and agreed to proceed.
Pre-operative Assessment
Orthopantomogram (OPG) taken.
Pre-operative CBCT taken to assess the condition of the roots and surrounding bone.
Anesthesia
Local anesthesia for the extraction of teeth #27 and #28.
Surgical Procedure
Patient cleaned and draped.
Incision made, buccal flap raised.
Bone guttering performed.
Teeth #27 and #28 extracted, with cortical bone fractured and elevated out.
Palatal root of tooth #27 fractured and initially inaccessible.
Follow-up Procedure
Advised surgical removal of the retained palatal root of tooth #27.
Patient agreed to proceed, and informed consent was obtained.
Local anesthesia infiltration increased.
Incision made, buccal flap raised again.
Further bone guttering performed to access the palatal root of tooth #27.
Palatal root picked out using periotomes and root picks.
Curettage and irrigation with saline.
Bone substitute placed for primary closure.
Hemostasis achieved and post-operative instructions given.
Post Operation Gallery
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Post-operative Assessment
Orthopantomogram (OPG) taken.
Pre-operative CBCT taken to assess the condition of the roots and surrounding bone.