This emergency patient arrived at my office in pain. He was on vacation from London. His dentist removed a portion of this lower left molar but was going to refer the patient to a specialist to complete the extraction. The following therapy was performed today. Local anesthesia was administered ( topical plus carbocaine 3 % via mandibular block  infiltration of septicaine to the soft tissues adjacent to the tooth ). The remaining crown was cut off and the roots were separated. The apical segment of the distal root fractured off. If you look carefully at the radiograph this root segment has a curve that embeds within superior bone. The question then becomes, should you leave this root segment or attempt to remove it. Removing this segment requires good visualization therefore a full thickness flap and excision of bone is necessary adding to the morbidity of the procedure. Clinical experience generally suggests that removal of the segment would avoid future complications.

Once a flap was raised and bone excised the root tip was exposed and gently removed. To compensate for the bone destruction, a graft was placed and the flap sutured closed with resorbable gut suture.  The patient  was given appropriate analgesics and a supply of antibiotics to be taken only if his clinical status deteriorates. As a general dentist, learning to perform difficult surgical procedures requires extra efforts. Over the years I have supplemented reading with visiting specialists on a regular basis.