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Surgical Removal of Ankylosed Retained Root – Tooth #22 with Crown and Bridge Preparation

Surgical Procedure

Chief Complaint

Patient presented with pain and tenderness associated with the upper left lateral incisor (tooth #22) with a previously re-cemented post-core and crown.

Clinical Findings

Tooth #22

  • Previously re-cemented post-core and crown

  • History of coronal fracture

  • Very tender to percussion (vertical and lateral)

  • Mobility and probing depth within normal limits

  • Metallic sound on percussion

  • Suspected dense alveolar bone and possible ankylosis

  • Possible failure of prior root canal treatment due to leakage or root crack

Teeth #11, #12, #13, #21, #23

  • Asymptomatic

  • Not tender to percussion (vertical and lateral)

  • Mobility and probing depth within normal limits

  • Gross tooth-coloured restorations with leakage and recurrent caries

Treatment Plan

  • Attempt extraction of tooth #22 under local anesthesia, with escalation to surgical removal if complicated

  • Surgical removal of retained root of tooth #22 if conventional extraction unsuccessful

  • Crown preparation for teeth #11, #12, and #13

  • Bridge preparation spanning teeth #21 to #23

Pre-operative Assessment

  • Clinical and radiographic assessment performed

  • Risks, benefits, alternatives, and procedural steps explained

  • Patient understood and agreed to proceed

  • Informed consent obtained

Pre-operative CBCT taken for tooth #22

Anesthesia

Local anesthesia via infiltration from teeth #13 to #23

Surgical Procedure

Tooth #22 – Extraction and Surgical Removal

  • Local anesthesia administered

  • Initial extraction attempt performed

  • PFM crown dislodged

  • Post-core and coronal tooth structure dislodged

  • Cracked root noted

  • Tooth remnants could not be luxated due to suspected ankylosis

  • Decision made to proceed with surgical removal

Surgical steps:

  • Patient cleaned and draped

  • Buccal incision made and flap raised

  • Bone guttering performed

  • Tooth sectioned

  • Retained root elevated and removed in five pieces

  • Root fracture and splitting noted

  • Thorough curettage performed

  • Surgical site irrigated with saline

  • Two bone substitute sponges placed for secondary closure

  • Hemostasis achieved

  • Post-operative instructions provided

Crown and Bridge Preparation

  • Crown preparation performed on teeth #11, #12, and #13

  • Bridge preparation performed spanning teeth #21 to #23

  • Upper and lower full-arch digital scans taken

  • Occlusion digitally recorded

  • Shade selected: 3M2

Temporary restorations placed

Post-operative Assessment

  • Post-operative CBCT taken for surgical site #22

  • No residual root fragments noted

  • Inferior dental nerve and adjacent teeth not involved

  • Patient reassured

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