Removal of Impacted Tooth #38 and Extraction of Tooth #37
Surgical Removal
Impacted Wisdom Tooth
Chief Complaint
Patient reported pain and swelling, requesting the removal of tooth #38.
Clinical Findings
Tooth #38: Impacted with long, thin roots and bulbous apices in very close contact with the Inferior Dental Nerve (IDN). Distal-occlusal (do) caries to pulp. Very tender to percussion (TTP), TTPp. Mobility within normal limits (WNL).
Tooth #37: Distal (d) caries to pulp. Very TTP, TTPp. Mobility WNL.
Treatment Plan
Treatment Options:
1. LA OP removal of tooth #38 and LA XAP of tooth #37
2. LA OP removal of tooth #38 and RCT, PC, Crown for tooth #37
Patient chose option 1.
Pre-operative Assessment
Pre-operative CBCT taken.
Risks of paresthesia to lower lip and tongue explained.
Procedures thoroughly explained.
Patient understood and agreed to proceed with LA OP removal of tooth #38.
Informed consent obtained.
Anesthesia
LA block administered for left IDN, LN, and LBN.
Surgical Procedure
Preparation:
Patient cleaned and draped.
2. Removal of #38:
Incision made, buccal flap raised.
Bone guttering performed.
Tooth sectioned and elevated out in 11 pieces.
Curettage and irrigation with saline.
BSS x 07 placed for primary closure.
Haemostasis achieved.
3. Extraction of #37:
LA XAP performed with bone guttering due to long roots and dense bone.
Curettage and irrigation with saline.
BSS placed for primary closure.
Haemostasis achieved.
Post-operative instructions (POI) given.
Post Operation Gallery
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Post-operative Assessment
Pre-operative CBCT taken.
Risks of paresthesia to lower lip and tongue explained.
Procedures thoroughly explained.
Patient understood and agreed to proceed with LA OP removal of tooth #38.
Informed consent obtained.