Impacted Wisdom Tooth Removal #38, Debridement #37, Extraction #36
Surgical Removal
Debridement, Extraction, Impacted Wisdom Tooth
Chief Complaint
Patient presented with tooth remnants at #37 site and pain in the third quadrant. Tooth #36 was very tender to palpation and percussion. Deep distal probing depth noted, potentially involving the apex, with furcation involvement classified as class II.
Clinical Findings
Tooth #37: Remnants noted in gingival tissue, impacted #38 observed on CBCT.
Tooth #36: Very tender to palpation and percussion, filling to pulp, periapical lesions on mesial and distal roots, perio-endo involvement, classified as a hopeless tooth.
General: Furcation involvement (class II), deficiency at margin of #36, distal bone loss extending to the apex.
Treatment Plan
LA OP removal of impacted #38 wisdom tooth
LA OP debridement of #37 site
LA XAP #36
Pre-operative Assessment
CBCT taken after discussion and quotation with the patient.
Impacted #38 noted, remnant roots of #37 in bone at missing site observed.
Enamel fins noted in gingival tissue.
PA lesions on mesial and distal roots of #36 identified.
Risks of paraesthesia to lower lip and tongue, oro-antral perforation (OAP), and oro-antral fistula (OAF) explained.
Detailed procedures explained to patient.
Informed consent obtained.
Anesthesia
Local anesthesia block (left IDN, LN, and LBN).
Surgical Procedure
Preparation:
Patient cleaned and draped.
Incision made, buccal flap raised.
2. Extraction of #38:
Bone guttering performed.
Tooth sectioned.
#38 elevated out in 2 pieces.
Curettage and removal of granulation tissue.
Remnant tooth structures at #37 site removed.
Non-bleeding heavily calcified remnants in bone at #37 site removed using chisel.
3. Debridement of #37 site (LA OP):
Detailed debridement performed.
Granulation tissue removed.
4. Extraction of #36 (LA XAP):
Curettage performed.
Granulation tissue removed.
Sites irrigated with saline.
Nine bone support structures (BSS) placed for primary closure.
Achieved haemostasis, post-operative instructions (POI) provided.
Post Operation Gallery
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Post-operative Assessment
CBCT taken after discussion and quotation with the patient.
Impacted #38 noted, remnant roots of #37 in bone at missing site observed.
Enamel fins noted in gingival tissue.
PA lesions on mesial and distal roots of #36 identified.
Risks of paraesthesia to lower lip and tongue, oro-antral perforation (OAP), and oro-antral fistula (OAF) explained.
Detailed procedures explained to patient.
Informed consent obtained.