Surgical extraction - Tooth #27

The following report details the extraction of tooth #27 from the patient, which presented several challenges during the procedure. The primary complications included cervical caries, curved and bulbous roots, difficulty in luxating the tooth, and the absence of an adjacent first molar for engagement. Despite these challenges, the extraction was successfully completed, albeit with extended surgical time and additional measures taken to prevent infection.

Procedure Details:

• Initial Assessment: Upon examination, tooth #27 was found to have cervical caries, increasing the likelihood of fractures during extraction. Furthermore, the tooth had three curved and bulbous roots, complicating the procedure.

• Luxation Attempts: Initial attempts were made to luxate the tooth, but it did not easily release from the socket. On the distal side, force applied risked affecting the adjacent third molar.

• Crown Fracture: During the extraction process, when buccal force was applied, the crown of the tooth fractured, adding to the complexity of the procedure.

• Elevator Engagement: To facilitate extraction, an elevator was engaged on the buccal side in the furcation area. The mesiobuccal root was successfully separated and extracted using a straight elevator.

• Root Separation: However, the distobuccal and palatal roots remained joined at the furcation and could not be easily removed. To address this, a high-speed handpiece and bur were used to separate the distobuccal and palatal roots, after which they were extracted using BD forceps.

Complications:

• Extended Surgical Time: Due to the complexity of the procedure, the surgery time was extended beyond the usual duration.

Post-Extraction Care:

• Socket Suturing: To ensure the clot did not dislodge and to promote proper healing, the socket was sutured meticulously.

• Antibiotics: The patient was prescribed a course of antibiotics as a precautionary measure due to the prolonged surgical time and the potential for infection.

Follow-Up: The patient was advised on post-operative care, including maintaining proper oral hygiene, refraining from consuming hard or sharp foods, and attending follow-up appointments as scheduled. The patient was also given guidance on pain management and advised to contact the clinic if any unusual symptoms or complications arose.

Conclusion: The extraction of tooth #27 presented several challenges due to cervical caries, curved and bulbous roots, and a lack of engagement points. Despite these difficulties, the extraction was successfully completed, and appropriate post-operative care measures were implemented to ensure the patient's well-being.

This case was done with Dr. Muhammad Ahmed and Dr. Shahid Nawaz at Farooq Hospital Westwood Branch, Lahore.