CASE STUDY: Removal of a fractured tooth root and closure of oro-antral-communication (OAC)

Patient history

A 55 year old male patient presented with a fractured root of tooth 26. He indicated that he wanted the root removed.
The patient had no relevant medical history. Ten days prior, the fractured root had been left in-situ after extraction of tooth 26 had been performed.
On examination, the retained palatal root of tooth 26 could be seen.
The pre-operative OPG (orthopantomogram – a wide view x-ray of the lower face) and post-operative PA (periapical radiograph – showing the individual tooth and tissue surrounding the apex) were viewed.

Diagnosis

The diagnosis made was the retained palatal root of tooth 26 with a possible oro-antral-communication (OAC). If left untreated, there was the risk of infection.

Treatment

The agreed upon treatment was to perform the following steps under local anaesthesia:
1. remove the retained tooth root
2. investigate the possible OAC (sinus openings into the mouth)
3. if OAC was present, achieve a primary closure of the OAC.
During treatment, the retained root of tooth 26 was removed. An OAC was identified and treated with the buccal advancement flap procedure (this is where incisions are made into the buccal mucosa to create a flap to cover the OAC. The flap is then sutured to the palatal mucosa to achieve complete closure of the OAC).

Results

The removal of the retained root of tooth 26 was successful and primary closure of the identified OAC was achieved. The area healed well and the patient did not have the discomfort of experiencing an untreated OAC. The patient was happy with the outcome of the treatment.