Letters to the Editor

I wish to report a rare but clinically important risk during removal of lower third molar teeth. A 71-year-old female attended surgery for the removal of the lower left wisdom tooth (LL8) under local anaesthesia. The tooth had a history of pain and unrestorable subgingival caries. There was no relevant medical history. A pre-operative periapical radiograph was used to plan removal (Figure 1).

Routine simple elevation was carried out on the mesial aspect of the LL8. The majority of the tooth was removed, however, a third, lingually positioned root had separated and remained mobile in the socket. A curved clip was used to attempt retrieval but became caught on septal bone, which broke away, leading to the root disappearing into the lingual space. The socket was rechecked following copious irrigation confirming no root in sight.

The procedure was stopped immediately, haemostasis achieved and the patient informed in an open and honest manner. OPG facility allowed approximation of the position of the root (Figure 2). A maxillofacial on-call DCT was called for further management, who advised sending an urgent referral via FDS to an OMFS outpatient unit, antibiotic prophylaxis and monitoring following discharge. The patient was called in the afternoon. She explained that she was completely asymptomatic and had regained feeling following anaesthesia. A follow-up appointment found no complaints or signs of infection or swelling in surrounding tissues. The patient was assessed in an OMFS outpatient setting one week later and awaits a CT scan for locating the root.