Surgical Removal of #26
Surgical Removal
Extraction
Chief Complaint
Patient suspected tooth #28 as the source of pain.
Clinical Findings
Tooth #28:
Non-tender to percussion (NTTP) and non-tender to palpation (NTTPp).
Mobility and probing depth within normal limits (WNL).
Bite test negative.
Transillumination test negative.
Caries present.
Tooth #26:
Very tender to percussion (TTP) and tender to palpation (TTPp).
Mobility and probing depth WNL.
Slight metallic sound on percussion.
Dense bone and potential ankylosis considered.
Bite test consistently positive.
Transillumination test inconclusive.
CBCT Findings:
Tooth #26 with long, divergent roots and curved tips.
Radiopaque bone surrounding tooth #26.
Root of #26 very close to maxillary sinus.
Diagnosis:
Tooth #26 cracked, involving pulp, and showing pulpitis.
Treatment Plan
Recommended:
Root Canal Treatment (RCT), post core (PC), and crown (estimated around $3000, inclusive of GST and using full Zirconia Crown).
Alternative:
X-ray of #26 (estimated $150–$300).
Potential tooth fracture and need for local anesthesia (LA) and oral surgery (OP) removal of retained roots (estimated $1000+++).
Possible implant, bridge, or denture to replace the missing tooth or leave as an empty space.
Pre-operative Assessment
Patient chose the alternative option despite the explained complications for the loss of #26.
Pre-operative CBCT taken.
Anesthesia
Local anesthesia infiltration for tooth #26.
Local anesthesia X-ray (XAP) of #26.
Surgical Procedure
Patient cleaned and draped.
Incision made, buccal flap raised.
Bone guttering performed.
Tooth #26 sectioned and elevated in 4 pieces.
Curettage and irrigation with saline.
BSS x 8 placed for secondary closure.
Hemostasis achieved, post-operative instructions (POI) given.
Post-operative CBCT taken.
Post Operation Gallery
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Post-operative Assessment
Patient chose the alternative option despite the explained complications for the loss of #26.
Pre-operative CBCT taken.