Post-Operative Wisdom Tooth Surgery Complications #38

Chief Complaint

Severe pain at the site of the wisdom tooth extraction (#38).

Patient reported that the surgery was performed on December 2, 2022, by a previous operator. The patient experienced dislodged or loose sutures and a loose flap post-operatively, but was reassured that the sutures were secure and the flap was anchored.
The patient returned to the previous operator on December 7, 2022, with complaints of pain and was diagnosed with a dry socket at the #38 site. The wound was irrigated, medicament was placed, and sutures were applied.
Despite this treatment, the patient continued to experience severe pain and sought a second opinion.
Intraoral examination revealed a very loose flap with two sutures not anchoring the flap, pus exudate in the socket, a small piece of dry socket medicament soaked in pus, and food trapped under the flap and in the socket. The socket showed infected and pus-covered bare bone.

Minor surgical procedure to expose the socket and perform open flap debridement.
Medicament packing and placement in the socket.
Primary wound closure with suturing.
Post-operative CBCT.
Antibiotic therapy.

A pre-operative CBCT scan showed the inferior dental nerve (IDN) very close to the socket, with no evidence of bone guttering. The IDN was not affected during surgery, and no remnant tooth structure was noted in the socket.
Tooth #28 (m) presented with caries and was non-functional.

Local anesthesia blocks were administered to the left inferior dental nerve (IDN), lingual nerve (LN), and long buccal nerve (LBN).

Old sutures were removed, and the flap was elevated.
Socket debridement and flap debridement, including beneath the flap and surrounding bone, were performed.
The area was irrigated with saline, and bleeding was stimulated.
Aveogel was packed into the socket.
Primary closure was achieved with 06 BSS sutures.

A pre-operative CBCT scan showed the inferior dental nerve (IDN) very close to the socket, with no evidence of bone guttering. The IDN was not affected during surgery, and no remnant tooth structure was noted in the socket.
Tooth #28 (m) presented with caries and was non-functional.