Digitally Guided Flapless Atraumatic Extraction (DSG-FARE) of a Soft-Tissue–Impacted Palatal Root Fragment: A Case Report

Abstract

Background: Extraction of impacted or retained root fragments in the posterior maxilla may be surgically challenging due to limited access and close proximity to critical anatomical structures. Conventional flap-based approaches may increase morbidity and the risk of iatrogenic injury. Case Presentation: A 20-year-old healthy female presented with a soft-tissue–impacted palatal root fragment of a previously extracted maxillary first molar. Cone-beam computed tomography (CBCT), initially obtained for comprehensive digital implant planning, revealed an extremely close proximity of the fragment to the adjacent second molar root and the maxillary sinus floor. Technique:  A digitally guided flapless atraumatic extraction technique was planned to use merged CBCT and intraoral scan data. A surgical guide was designed to allow controlled access, guided drilling, and traction-based extraction through a minimally invasive approach. Outcome: The root fragment was removed successfully without flap elevation or damage to adjacent structures. Postoperative healing was uneventful, with minimal discomfort and favorable soft tissue outcomes. Clinical Significance: This report describes a novel application of established digital planning and guided traction based atraumatic extraction techniques to enable minimally invasive removal of a retained palatal root fragment in an anatomically sensitive region.