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Comprehensive Removal of Painful Teeth and Retained Roots in the 3rd and 4th Quadrants

Surgical Removal
Retained Root
Comprehensive Removal of Painful Teeth and Retained Roots in the 3rd and 4th Quadrants

Chief Complaint

Patient sought removal of painful teeth in the 3rd and 4th quadrants.


Clinical Findings

  • Tooth #47: Cracked and split with pus exudate, very tender to percussion (TTP) and palpation (TTPp), diagnosed as hopeless.

  • Tooth #38: Periodontal-endodontic involvement, diagnosed as hopeless, very TTP and TTPp.

  • Tooth #36: Retained roots, tender to percussion (TTP), not tender to palpation (NTTPp), mobility and probing depth (PD) within normal limits (WNL).

Treatment Plan

  • Extraction of teeth #38 and #47.

  • Removal of retained roots of tooth #36.

Pre-operative Assessment

  • Pre-operative CBCT taken.

  • Risks of paresthesia to lower lip and tongue, and oroantral perforation (OAP)/oroantral fistula (OAF) discussed.

  • Procedures explained, patient understood and agreed to proceed.

  • Informed consent obtained.

Anesthesia

Local anesthesia administered: Right and Left Inferior Dental Nerve (IDN), Lingual Nerve (LN), and Long Buccal Nerve (LBN) blocks.

Surgical Procedure

  1. Tooth #36:

  • Patient cleaned and draped.

  • Incision made, buccal flap raised.

  • Bone guttering performed.

  • Retained roots elevated out in three pieces.

  • Curettage and irrigation with saline.

  • BSS x 03 placed for primary closure.

  • Achieved haemostasis and provided post-operative instructions (POI).

2. Tooth #38:

  • Local anesthesia administered.

  • Profuse bleeding noted.

  • Curettage and irrigation with saline.

  • BSS x 05 placed for primary closure.

  • Achieved haemostasis and provided POI.

3. Tooth #47:

  • Local anesthesia administered.

  • Profuse bleeding noted.

  • Curettage and removal of granulation tissue.

  • Irrigation with saline.

  • BSS x 05 placed for primary closure.

  • Achieved haemostasis and provided POI.

Post Operation Gallary

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Post-operative Assessment

  • Pre-operative CBCT taken.

  • Risks of paresthesia to lower lip and tongue, and oroantral perforation (OAP)/oroantral fistula (OAF) discussed.

  • Procedures explained, patient understood and agreed to proceed.

  • Informed consent obtained.

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