Surgical Removal of Retained Roots of #46
Surgical Removal
Retained Root
Chief Complaint
Severe pain and tenderness in the lower right molar region.
Clinical Findings
Tooth #46 (distal-occlusal) presents with caries extending to the pulp.
Very tender to palpation (TTP) and percussion (TTPp)
Mobility present, probing depths within normal limits (WNL)
Slight metallic sound on percussion, suggesting possible ankylosis
Periapical (PA) radiograph shows extensive caries towards buccal and lingual walls with sound bone levels
Treatment Plan
Recommended Treatment: Root canal treatment (RCT) followed by post and crown (PC) using a full Zirconia Crown.
Alternative Treatment: Extraction (XAP) of tooth #46, with the possibility of complications such as retained roots. Post-extraction options include implant, bridge, denture, or leaving the space empty.
The patient chose the extraction option despite being informed of the potential complications.
Pre-operative Assessment
Pre-operative Cone Beam Computed Tomography (CBCT) scan taken
Findings: Fractured crown with retained roots in tooth #46, consisting of three roots—two long and wide (mesio-buccal and disto-buccal) and one thin and curved (disto-lingual)
Anesthesia
Local anesthesia block for the right inferior dental nerve (IDN), lingual nerve (LN), and long buccal nerve (LBN).
Surgical Procedure
Initial extraction attempt resulted in a coronal fracture of tooth #46, leaving firm retained roots.
Proceeded with a more invasive procedure to remove retained roots:
Patient cleaned and draped
Incision and buccal flap raised
Bone guttering performed
Tooth sectioned into multiple pieces
Retained roots of tooth #46 elevated out in eight pieces
Curettage and irrigation with saline
BSS sutures placed for secondary closure
Post Operation Gallery
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Post-operative Assessment
Pre-operative Cone Beam Computed Tomography (CBCT) scan taken
Findings: Fractured crown with retained roots in tooth #46, consisting of three roots—two long and wide (mesio-buccal and disto-buccal) and one thin and curved (disto-lingual)