Removal of Impacted Tooth #38 and Extraction of Tooth #28
Surgical Removal
Chief Complaint
Patient requested removal of impacted tooth #38 and extraction of tooth #28.
Clinical Findings
Tooth #38: Impacted
Tooth #28: Patient requested extraction
Treatment Plan
Removal of impacted tooth #38 under local anesthesia operative procedure (LAOP)
Extraction of tooth #28 under local anesthesia (LA XAP)
Pre-operative Assessment
Pre-operative CBCT taken
Inferior dental nerve (IDN) plotted
Risks of paresthesia to the lower lip and tongue, and potential for oroantral perforation/fistula (OAP/OAF) explained
Procedures and costs explained
Patient understood and agreed to proceed
Informed consent obtained
Anesthesia
LA block: left inferior dental nerve (IDN), lingual nerve (LN), and long buccal nerve (LBN)
LA infiltration
Surgical Procedure
Tooth #38:
Patient cleaned and draped
Incision made, buccal flap raised
Bone guttering performed
Tooth sectioned
#38 elevated out in four pieces
Curettage and irrigation with saline
Bioactive synthetic scaffold (BSS) placed x4 for primary closure
Hemostasis achieved, post-operative instructions given
2. Tooth #28:
Extraction under local anesthesia
Irrigation with saline
Hemostasis achieved, post-operative instructions given
Post-operative Assessment
Post-operative CBCT taken
IDN plotted, no involvement noted
Maxillary sinus and IDN spared