Surgical Removal of Retained Roots – Tooth #46
Surgical Procedure
Chief Complaint
Patient attended for management of a fractured lower right molar (tooth #46) with retained roots.
Clinical Findings
Pre-operative CBCT reviewed together with the patient
Tooth #46:
Fractured with retained roots
Previously root-filled
Two-rooted tooth
Wide and flattened mesio-buccal (MB) and disto-buccal (DB) roots
Additional CBCT finding:
Periapical lesion noted at apex of tooth #41
Deep filling extending to the pulp
Periapical involvement affecting neighbouring teeth
Treatment Plan
Surgical removal of retained roots of tooth #46 under local anesthesia
Discussion regarding root canal treatment for tooth #41
Patient declined Medisave claim for the procedure
Pre-operative Assessment
CBCT findings explained and discussed with the patient
Risks, benefits, and procedural steps explained
Specific risks of paraesthesia involving the lower lip and tongue discussed
Patient understood and agreed to proceed
Informed consent obtained
Anesthesia
Local anesthesia administered
Surgical Procedure
Patient cleaned and draped
Buccal incision made and flap raised
Bone guttering performed
Tooth sectioned
Retained roots of tooth #46 elevated and removed in two pieces
Thorough curettage performed
Surgical site irrigated with saline
Five bone substitute sponges placed for secondary closure
Hemostasis achieved
Post-operative instructions provided
Post-operative Assessment
Post-operative CBCT taken
No residual root fragments noted at site #46
Inferior dental nerve and adjacent teeth not involved
Periapical lesion at tooth #41 reiterated and discussed
Patient reassured