Surgical Removal of Impacted #48 with Extraction of #47 Due to Advanced Caries and Periodontal Bone Loss
Surgical Procedure
Chief Complaint
Patient complained of pain over the lower right posterior jaw region, initially indicating tooth #46.
Clinical Findings
Pain traced to tooth #47. Examination revealed:
Severe tenderness to percussion and palpation at #47
Deep distal and disto-buccal periodontal pockets at #47
Distal caries extending to pulp on #47
Distal bone loss >50% on #47
Tightly impacted #48 with significant food impaction between #47 and #48
Impacted #48 contributing to distal destruction of #47
Mobility within normal limits
CBCT taken pre-operatively
Additional findings:
Large periapical lesions on #17 and #27 (periodontally compromised, poor prognosis)
Bone loss noted on #23 (distal-palatal), #43, #44, #45
Occlusal radiolucency on #18 and #28
Impacted #38 and #48
Treatment Plan
Patient elected:
Surgical removal of impacted #48
Extraction of tooth #47
Future implant placement planned to replace #47
Pre-operative Assessment
Risks of inferior alveolar nerve and lingual nerve paraesthesia explained.
Procedures discussed in detail.
Patient understood and consented to proceed with treatment.
Anesthesia
Local anaesthesia administered via right inferior dental nerve block, lingual nerve block, and long buccal nerve block.
Surgical Procedure
Patient cleaned and draped.
For #48:
Incision made
Buccal flap raised
Bone guttering performed
Tooth sectioned
Impacted tooth removed in five pieces
Curettage performed
Irrigation with saline
Primary closure achieved with sutures
Hemostasis confirmed
For #47:
Extraction performed under local anaesthesia
Irrigation with saline
Hemostasis achieved
Post-operative OPG taken:
No retained root fragments
Inferior alveolar nerve intact and not involved in surgery
Post-operative Assessment
Hemostasis achieved.
Surgical sites stable.
Patient reassured and discharged in stable condition.