Extraction of #18 and #48
Surgical Removal
Chief Complaint
Patient presented with pulsatile pain that began the previous evening (around 5 PM). Pain medication provided temporary relief. Pain worsened when lying down, and the patient was initially uncertain whether it originated from the upper or lower jaw. During examination, the patient indicated pain localized to the lower region.
Clinical Findings
#16: Secondary caries; sensitive to percussion; normal cold and bite test response.
#18: Deep pocket (>6 mm); positive to cold, percussion, and bite tests; signs of periapical infection.
#48: Caries on mesial surface; positive to cold, percussion, and bite tests.
Radiographic findings:
Bone loss around #18.
Radiolucency on mesial of #48.
Possible sinusitis on left side, but no sinus tenderness or tooth sensitivity noted.
Treatment Plan
Extraction (XAP) of #18 and #48.
Risks and possible complications, including those associated with local anesthesia and the procedure itself, were explained to the patient.
Patient consented to proceed.
Pre-operative Assessment
Medical history reviewed — no contraindications reported.
Indications for extraction confirmed radiographically and clinically.
Anesthesia
Topical anesthesia applied.
#18: 1 cartridge Scandonest 2% Mepivacaine with adrenaline via buccal and palatal infiltration.
#48: 2 cartridges Scandonest 2% Mepivacaine with adrenaline via inferior dental nerve (IDN) block, long buccal block, intraligamental, and infiltration.
Surgical Procedure
Teeth #18 and #48 extracted intact.
Sockets curetted and irrigated thoroughly.
Haemostasis achieved.
Post-operative instructions provided.
Post-operative Assessment
Patient tolerated procedure well.
Advised on pain management and oral hygiene.
Provided medical certificate.