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Surgical Extraction and Retained Root Removal in the 2nd Quadrant

Surgical Removal
Wisdom Tooth
Surgical Extraction and Retained Root Removal in the 2nd Quadrant

Chief Complaint

Patient reported pain in the 2nd quadrant.

Clinical Findings

  • Teeth #27 and #28: Very tender to percussion (TTP), not tender to palpation (NTTPp).

  • Mobility and probing depth within normal limits (WNL).

  • Metallic sound on percussion indicating very dense bone.

  • OPG taken.

  • Diagnosis: Caries to pulp in teeth #27 (distal) and #28 (mesial), pulpitis, very long roots.

Treatment Plan

  1. Extraction of teeth #27 and #28.

  2. Potential retained root removal of #27 if complications arise.

Pre-operative Assessment

  • Advised options included extraction and root canal treatment with crowning or extraction of both teeth.

  • Patient chose extraction of both teeth (#27 and #28).

  • Risks and procedures explained, patient understood and agreed to proceed.

  • Informed consent obtained.

  • Pre-operative CBCT taken.

Anesthesia

Local anesthesia administered for extraction of #27 and #28.

Surgical Procedure

  1. Extraction of Teeth #27 and #28:

  • Noted very dense bone.

  • Cortical bone fractured and elevated out with teeth #27 and #28.

  • Distal root of #27 fractured, palatal root inaccessible.

2. Removal of Retained #27 Palatal Root:

  • Local anesthesia infiltration increased.

  • Patient cleaned and draped.

  • Incision made, buccal flap raised.

  • Bone guttering performed to access #27 palatal root.

  • Palatal root of #27 picked out using periotomes and root picks.

  • Curettage and irrigation with saline.

  • BSS x 04 placed for primary closure.

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

Post Operation Gallary

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Post-operative Assessment

  • Advised options included extraction and root canal treatment with crowning or extraction of both teeth.

  • Patient chose extraction of both teeth (#27 and #28).

  • Risks and procedures explained, patient understood and agreed to proceed.

  • Informed consent obtained.

  • Pre-operative CBCT taken.

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