Surgical Extraction with Bone Graft EG

Specialty: Dentist **Surgical Extraction with Bone Graft EG** **Subjective** Patient presents with non-restorable tooth 26, planned extraction with grafting. Relevant past medical/dental history: Patient is a 45-year-old non-smoker with well-controlled hypertension. No known allergies. Dental history includes routine check-ups and a previous root canal on tooth 26 five years ago, which has now failed. **Assessment** E/O findings: Mild facial swelling on the left maxillary region, no lymphadenopathy. I/O findings: Tooth 26 shows significant buccal and palatal decay extending subgingivally. Mobility grade 2. Buccal bone appears thin. Radiographic findings – root morphology, bone volume, periapical area, sinus proximity: Periapical radiolucency noted around mesiobuccal root of 26. Roots are divergent. Adequate bone volume mesial and distal, but buccal plate is compromised. Sinus floor is approximately 3mm superior to the apices of the buccal roots. Diagnosis: Non-restorable tooth 26 due to extensive decay and periapical pathology, requiring surgical extraction and bone grafting for future implant placement. **Consent** Risks of surgical extraction and graft discussed including pain, swelling, bleeding, infection, sinus exposure, nerve injury, graft failure, need for further grafting, delayed healing. Patient understood and gave verbal consent. **Treatment** Local anaesthetic: 2 cartridges of 2% Lidocaine with 1:100,000 Epinephrine, given as buccal and palatal infiltration. Full-thickness flap raised at site of tooth 26. Tooth sectioned and extracted surgically. Socket debrided and irrigated. Bone graft material placed: Bio-Oss, 0.5cc mixed with patient's blood. Collagen membrane (if used): yes Flap repositioned and sutured with 4/0 Vicryl interrupted sutures. Haemostasis achieved. **Post-operative Instructions** Patient given verbal and written post-operative instructions. Analgesia/antibiotic prescribed: Amoxicillin 500mg TDS for 7 days, Ibuprofen 400mg PRN for pain. Next visit: Suture removal in 7 days, followed by implant planning in 3 months. **Other Notes** Patient expressed some anxiety regarding the procedure but was reassured. Advised on soft diet and strict oral hygiene. Will review progress at suture removal appointment on 8 November 2024.