Surgical Removal of Retained Roots – Tooth #24
Surgcal Removal
Chief Complaint
Pain and dislodged filling on upper left premolar (#24).
Clinical Findings
Tooth #24:
Very TTP, TTPp
Mobility WNL
Probing depth WNL
Bite test negative
Transillumination test negative
Deep caries extending to pulp
Sub-crestal caries
Diagnosis: Pulpitis due to caries
Initial extraction attempt resulted in coronal fracture, leaving firm retained roots.
Pre-operative X-ray showed:
Fractured tooth with retained buccal and palatal roots
Long roots embedded in very dense bone
Treatment Plan
Option 1 (chosen):
XAP #24
If roots retained → Surgical removal under LA
Future replacement options discussed (implant recommended)
Option 2 (not chosen):
RCT → Post-core → Crown
Less favourable due to sub-crestal caries and need for crown lengthening, which may compromise bone level of #25
Pre-operative Assessment
Risks, benefits, pros/cons of each option explained
Tooth replacement options discussed
Patient fully understood and chose extraction
Informed consent obtained for surgical removal of retained roots
Anesthesia
Local anesthesia for XAP and surgical procedure.
Surgical Procedure
Patient cleaned and draped
Incision made; buccal flap raised
Bone guttering performed
Tooth sectioned
#24 removed in 5 pieces
Curettage and saline irrigation
BSS × 3 placed for secondary closure
Hemostasis achieved
Post-operative instructions provided
Post-operative Assessment
Post-op PA taken
Complete removal confirmed; no remnants visualised
IDN and adjacent teeth not involved
Patient discharged in stable condition