Surgical Removal of Retained Roots – Tooth #36
Surgical Procedure
Chief Complaint
Pain in lower left posterior teeth with food trapping and bleeding between #36 and #37.
Clinical Findings
Tooth #36:
Very TTP, TTPp
Slight metallic percussion sound
Mobility WNL
Probing >20 mm to apices on distal with Class II furcation involvement
Bite test negative
Transillumination test negative
Distal cervical caries extending to pulp
Heavy subgingival calculus on distal root; mesial relatively clean
Perio-involved tooth with pulpal involvement
Initial elevation attempted but mesial root fractured, leaving firm retained roots.
Additional Findings (Pre-op OPG):
Retained long, thin, curved mesial root of #36
Impacted #38 and #28
Severe distal bone loss on #37 (guarded prognosis)
Significant bone loss on #47 distal
Treatment Plan
a) Extraction of #36
b) If roots fracture → LA surgical removal of retained roots
c) Curettage and socket debridement
d) Suturing for closure
Pre-operative Assessment
Risks, procedures, and possible complications (including lower lip and tongue paresthesia) explained
Quotation provided
Patient understood and agreed
Informed consent obtained
Anesthesia
Local anesthesia (XAP #36 + LA for surgical procedure)
Surgical Procedure
Patient cleaned and draped
Incision made; buccal flap raised
Bone guttering performed
Tooth sectioned
#36 removed in two pieces
Curettage and saline irrigation
BSS × 4 placed for secondary closure
Hemostasis achieved
Post-operative instructions given
Post-operative Assessment
Post-op OPG confirmed complete removal of roots
No remnants seen
IDN and adjacent teeth not involved
Patient stable upon completion