Surgical Removal of Retained Roots – Tooth #34
Surgical Procedure
Chief Complaint
Patient presented with pain associated with a severely decayed lower left premolar (tooth #34).
Clinical Findings
Pre-operative CBCT reviewed
Tooth #34 findings:
Gross sub-crestal caries extending into the pulp
Tender to percussion (vertical and lateral)
Mobility within normal limits
Probing depth within normal limits
Retained roots with purulent exudate noted
Previous surgical sites (#24, #25, #27):
Sutures present
Healing satisfactory
Patient afebrile
Treatment Plan
Surgical removal of retained roots of tooth #34 under local anesthesia
Suture removal for previous surgical sites (#24, #25, #27)
Post-operative imaging to confirm complete removal
Pre-operative Assessment
CBCT imaging assessed prior to surgery
Risks, benefits, and procedural steps explained
Patient understood and agreed to proceed
Informed consent obtained
Anesthesia
Local anesthesia via infiltration at tooth #34
Surgical Procedure
Sutures removed from sites #24, #25, and #27 (total of 9 bone substitute sponges removed)
Patient cleaned and draped
Buccal incision made at #34 and flap raised
Bone guttering performed
Tooth sectioned
Retained roots fractured and removed in two pieces using a minimally invasive approach
Thorough curettage performed
Surgical site irrigated with saline
Three bone substitute sponges placed for secondary closure at #34
Hemostasis achieved
Post-operative Assessment
Post-operative CBCT taken
No residual root fragments noted at site #34
Adjacent teeth and inferior dental nerve not involved
Post-operative instructions provided