Surgical Removal of Retained Roots – Tooth #14
Surgical Procedure
Chief Complaint
Patient complained of a cracked upper left premolar (tooth #14) after biting on meat the previous day, associated with pain on biting.
Clinical Findings
Patient presented with thick facial bones, squarish facial features, and tense masseter muscles
Tooth #14:
Tender to percussion (vertical and lateral)
Mobility within normal limits
Probing depth within normal limits
Positive bite test
Positive transillumination test
Deep mesio-distal crack with light refraction extending below gingival level
Crack extended beyond the crestal bone level
Crown fractured during gentle forceps application
Retained roots noted, firm and non-elevatable by conventional means
Tooth anatomy: two-rooted with long, thin roots
Treatment Plan
Initial extraction attempt under local anesthesia
Surgical removal of retained roots of tooth #14 due to failed conventional extraction
Pre- and post-operative CBCT imaging for assessment and confirmation of complete removal
Pre-operative Assessment
Periapical radiograph followed by CBCT imaging
Risks, benefits, alternatives, and tooth replacement options discussed
Proximity to maxillary sinus assessed
Patient understood the procedure and consented to surgical removal
Anesthesia
Local anesthesia administered
Surgical Procedure
Patient cleaned and draped
Buccal incision made and flap raised
Bone guttering performed
Tooth #14 sectioned
Retained roots elevated and removed in five pieces
Thorough curettage performed
Surgical site irrigated with saline
Three bone substitute sponges placed for secondary closure
Hemostasis achieved
Post-operative Assessment
Post-operative CBCT taken
No residual root fragments noted at site #14
Inferior dental nerve and adjacent teeth not involved
Very close proximity to maxillary sinus observed, but sinus not involved
Incidental retained root remnants at tooth #45 noted and shown to patient
Post-operative instructions given