Surgical Removal of #46 with Retained Roots
Surgical Removal
Extraction, Retained Root
Chief Complaint
Patient reports issues with tooth #46, which has caries extending to the pulp, with potential involvement of the furcation.
Clinical Findings
Tooth #46 shows significant tenderness to percussion (TTP), tenderness to palpation (TTPp), and normal mobility and probing depths. A slight metallic sound is heard on percussion, indicating the possibility of very dense bone or ankylosis.
Treatment Plan
Initial advice was to perform a periapical (PA) X-ray to determine the treatment plan:
1. Root Canal Treatment (RCT) followed by post and core (PC) and crown placement.
- Estimated cost around $3000++ (inclusive of GST, using full Zirconia Crown)
Recommended Option
2. Extraction (XAP) of tooth #46 with possible subsequent removal of retained roots.
- Estimated cost $200–$300 for extraction
- Possible additional cost of $1250+++ for retained roots removal if necessary
- Further options include implant, bridge, denture, or leaving the space empty
The patient opted for the extraction (Option 2) despite understanding the complications associated with the loss of tooth #46 and declined the initial X-ray.
Pre-operative Assessment
Local anesthesia (LA) block administered to the right IDN, LN, and LBN.
Tooth #46 fractured coronally during extraction attempts, leaving firm retained roots.
Patient was advised on the necessity of surgical removal of the retained roots.
Pre-op CBCT was taken and reviewed.
Anesthesia
LA block administered to the right IDN, LN, and LBN.
Surgical Procedure
Patient was cleaned and draped.
Incision made and buccal flap raised.
Bone guttering performed.
Tooth #46 sectioned and elevated out in six pieces.
Curettage performed, and the site irrigated with saline.
BSS x 05 placed for secondary closure.
Haemostasis achieved.
Post Operation Gallery
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Post-operative Assessment
Local anesthesia (LA) block administered to the right IDN, LN, and LBN.
Tooth #46 fractured coronally during extraction attempts, leaving firm retained roots.
Patient was advised on the necessity of surgical removal of the retained roots.
Pre-op CBCT was taken and reviewed.