Surgical Removal of Fractured Retained Roots of Upper Right First Molar (#16)
Surgical Removal
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Chief Complaint
Patient presented with pain on the lower right side. Clinical examination identified the source of pain as the upper right first molar (#16).
Clinical Findings
Lower right teeth:
No tenderness to percussion or palpation.
Normal mobility and periodontal probing depths.
Bite test indicated pain originating from the upper arch.
Tooth #16:
Very tender to percussion and palpation.
Normal mobility and probing depths.
Metallic percussion note suggestive of dense surrounding bone or possible ankylosis.
Positive bite test.
Positive transillumination test indicating a crack.
Clinical diagnosis: cracked tooth with pulpal involvement. Dense surrounding bone and possible ankylosis noted.
Treatment Plan
Treatment options discussed included:
Root canal treatment followed by post/core restoration and full-coverage crown.
Extraction of tooth #16 with replacement options if required.
The patient elected extraction.
Following crown fracture during extraction, surgical removal of the retained roots was planned.
Pre-operative Assessment
During extraction, the crown fractured, leaving retained distobuccal and palatal roots that could not be removed using conventional extraction techniques.
A pre-operative CBCT was obtained, confirming:
Three-rooted upper first molar.
Long, broad, flattened roots.
Very dense surrounding bone.
The patient was informed of:
The need for surgical retained root removal.
Risks of oro-antral communication (OAC) and oro-antral fistula (OAF).
Surgical procedure, expected healing, and possible complications.
The patient understood the treatment plan and provided informed consent.
Anesthesia
Local infiltration anaesthesia administered at tooth #16.
Surgical Procedure
Initial Extraction
Tooth #16 was extracted under local anaesthesia.
The clinical crown fractured during extraction.
Retained distobuccal and palatal roots remained firmly embedded due to dense surrounding bone and root morphology.
Surgical Removal of Retained Roots
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 sectioning carried out where necessary.
Retained roots removed in two sections.
Socket curetted and irrigated thoroughly with sterile saline.
Five interrupted sutures placed to achieve secondary closure.
Haemostasis confirmed.
A post-operative CBCT confirmed:
Complete removal of all retained root fragments.
Maxillary sinus remained intact.
Adjacent teeth were unaffected by the procedure.
Post-operative Assessment
Complete removal of retained roots confirmed radiographically.
No oro-antral communication detected.
Maxillary sinus remained intact.
Surgical site achieved satisfactory haemostasis.
Patient was reassured and provided with post-operative care instructions.