Surgical Removal of Retained Roots in Close Proximity to Maxillary Sinus – Tooth #27
Surgical Procedure
Chief Complaint
Patient presented for management of a grossly carious upper left molar (tooth #27) with retained roots.
Clinical Findings
Tooth #27:
Grossly carious retained roots
Tender to percussion (vertical); not tender to percussion (lateral)
Mobility and probing depth within normal limits
Slight metallic sound on percussion
Mesially tilted retained roots
Three-rooted tooth with long roots
Very close proximity to the maxillary sinus
Dense alveolar bone with suspected ankylosis
Periapical radiograph taken
Sound surrounding bone levels
Treatment Plan
Surgical removal of retained roots of tooth #27 under local anesthesia
Post-operative imaging to confirm complete removal and sinus integrity
Pre-operative Assessment
Pre-operative CBCT taken and reviewed
Risks, benefits, and procedural steps explained
Specific risks of oroantral communication and oroantral fistula 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 #27 elevated and removed in four 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
Maxillary sinus and adjacent teeth not involved
Patient reassured