Surgical Removal of Fractured Retained Roots of Upper Left First Molar (#26)

Surgical Removal

Chief Complaint

Patient presented with severe pain from a fractured, non-restorable upper left first molar (#26).

Clinical Findings

Tooth #26 had a large distal-occlusal temporary restoration with pulpal involvement and a mobile mesiopalatal cusp.
A subgingival fracture and firm retained roots were present, with possible dense bone or ankylosis.
The tooth had an incomplete root canal treatment performed approximately 15 years earlier.
CBCT showed three roots, including a long broad mesiobuccal root and thin divergent roots, close to the maxillary sinus.

Treatment Plan

Extraction of #26.
Surgical removal of retained roots if conventional extraction was unsuccessful.
Debridement and post-operative CBCT.

Pre-operative Assessment

The likelihood of crown fracture and retained roots, the surgical procedure, and the risk of oro-antral communication were discussed. The patient understood and consented.

Anesthesia

Local infiltration at #26.

Surgical Procedure

The clinical crown fractured during extraction, leaving firm retained roots.
A flap was raised, bone guttering performed and the roots sectioned for controlled removal in multiple pieces.
Four sutures were placed for secondary closure.
Post-operative CBCT confirmed complete removal with the maxillary sinus and adjacent teeth intact.

Post-operative Assessment

Complete root removal was confirmed radiographically.
Satisfactory haemostasis was achieved.
The maxillary sinus and adjacent teeth remained unaffected.