Surgical Removal of Fractured Retained Roots of Lower First Molar (#36) with Extraction of Adjacent Tooth (#35)
Surgical Procedure
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Chief Complaint
Patient presented with severe continuous pain from the lower left first molar (#36), which became significantly worse at night with throbbing pain that disturbed sleep.
Clinical Findings
Tooth #36
Severe tenderness to percussion and palpation.
Metallic percussion note suggestive of dense surrounding bone.
Normal mobility and periodontal probing depths.
Large leaking temporary restoration.
Extensive occlusal-distal caries with significant structural breakdown.
Mesial caries also present.
Prognosis considered guarded due to extensive destruction.
Tooth #35
Large restoration with recurrent distal-occlusal-buccal caries.
Lingually erupted and non-functional.
The patient had previously been referred for root canal treatment of #36 but was unable to obtain an immediate appointment.
Treatment Plan
Treatment options discussed included:
Root canal treatment with post/core restoration for #36 and management of caries on #35.
Extraction of #36 and #35 with future replacement options, including dental implants.
The patient elected extraction.
Following fracture of tooth #36 during extraction, surgical retained root removal was required.
Pre-operative Assessment
During extraction, the clinical crown fractured, leaving retained roots that could not be removed using conventional extraction techniques.
A pre-operative CBCT demonstrated:
Two-rooted lower first molar.
Long, wide, curved roots.
Dense surrounding alveolar bone.
The patient was informed of:
The need for surgical retained root removal.
Risk of temporary or permanent altered sensation (paraesthesia) affecting the lower lip and tongue.
Surgical procedure, expected healing, and possible complications.
The patient understood the treatment plan and provided informed consent.
Anesthesia
Right Inferior Dental Nerve Block (IDN)
Lingual Nerve Block (LN)
Long Buccal Nerve Block (LBN)
Surgical Procedure
Tooth #36
Initial extraction attempted under local anaesthesia.
Clinical crown fractured during extraction because of the complex root anatomy and dense surrounding bone.
Retained roots could not be removed using conventional techniques.
The patient was cleaned and draped under sterile protocol.
Buccal incision made and full-thickness flap elevated.
Bone guttering performed to expose the retained roots.
Tooth sectioned to facilitate removal.
Retained roots removed completely in multiple sections.
Socket thoroughly curetted and irrigated with sterile saline.
Tooth #35
Tooth extracted successfully under local anaesthesia.
Six interrupted sutures placed to achieve secondary closure.
Haemostasis confirmed.
A post-operative CBCT confirmed:
Complete removal of all retained root fragments.
Inferior Dental Nerve remained intact.
Adjacent teeth remained unaffected.
