Surgical Removal of Retained & Impacted Roots – Tooth #37
Surgical Procedure
Chief Complaint
Pain associated with grossly carious lower left molar (#37).
Clinical Findings
Tooth #37:
Gross caries (DOBL) extending to pulp
Very TTP, TTPp
Mobility WNL
Probing depth WNL
Pre-op CBCT:
Extensive caries extending buccally and lingually
Large periapical lesion involving both apices
Retained roots with coronal portion lost and attached to gingival tissues
Long, wide, flattened mesial and distal roots
#38 impacted and growing into the cavity of #37
Tooth #28:
Retained roots (not treated due to patient preference)
Diagnosis: Grossly carious non-restorable #37 with periapical pathology and retained/impacted root fragments.
Treatment Plan
Recommended:
LA OP removal of retained & impacted #37
LA OP removal of impacted #38
LA XAP of retained roots #28
Patient elected to proceed with surgical removal of #37 only.
Pre-operative Assessment
Risks explained, including paresthesia to lower lip and tongue
Procedure steps reviewed
Patient understood limitations of partial treatment
Informed consent obtained for LA OP removal of #37 only
Anesthesia
Left IDN, LN, and LBN block.
Surgical Procedure
Patient cleaned and draped
Incision made; buccal flap raised
Bone guttering performed
Tooth sectioned
#37 elevated in 3 pieces
Curettage and thorough saline irrigation
BSS × 3 placed for secondary closure
Hemostasis achieved; POI given
Post-operative Assessment
Post-op CBCT confirmed complete removal of roots
IDN intact, not involved
Adjacent teeth unaffected
Patient reassured