Buried and Impacted Tooth #38, #36

Chief Complaint

The patient presents with an impacted and deeply buried tooth #38, with associated cystic formation and infection.

Tooth #38 is impacted and displaced distally by a cyst, which is infected. The tooth is not visible in the mouth.
Pus exudate was observed on probing at the distal aspect of tooth #37.
Pre-operative CBCT revealed:

- Severe bone loss on buccal and lingual aspects of tooth #36, with Class III furcation involvement.

- Probing depth into the furcation area is more than 10mm.

- Sequential X-rays indicate increased bone loss and formation of a periapical (PA) lesion on the mesial root of tooth #36.

Local anesthesia (LA) for the surgical removal of the impacted and embedded tooth #38 and enucleation of the cystic lesion.
Extraction (XAP) of tooth #36 due to severe bone loss and PA lesion.

The patient was informed about the potential risks of paresthesia affecting the lower lip and tongue.
The procedures were thoroughly explained, and the patient provided informed consent, agreeing to proceed with the proposed treatments.

LA block administered to the left inferior dental nerve (IDN), lingual nerve (LN), and long buccal nerve (LBN).

The patient was cleaned and draped, followed by an incision and raising of a buccal flap.
Bone guttering and tooth sectioning were performed.
Tooth #38 was removed in 11 pieces.
The cystic lesion was enucleated, followed by curettage and irrigation with saline.
Primary closure was achieved using BSS x 02, with hemostasis and post-operative instructions (POI) provided.
LA extraction of tooth #36 was performed, followed by saline irrigation.
Secondary closure was achieved with BSS x 05, and hemostasis was established.

The patient was informed about the potential risks of paresthesia affecting the lower lip and tongue.
The procedures were thoroughly explained, and the patient provided informed consent, agreeing to proceed with the proposed treatments.