Surgical Extraction of Horizontally Impacted #38 and XAP of #28
Surgical Removal
Chief Complaint
Patient complains of pain on the lower left side in the region of tooth #37.
Clinical Findings
Tooth #37: Tender to percussion (TTP), non-tender to palpation (NTTPp), mobility within normal limits.
Probing depth significantly increased on distal of #37 with severe food impaction.
Bite test: Negative.
Transillumination test: Positive.
Crack lines noted on #36, #37, and #46 under transillumination; all negative on bite test.
Food impaction between #37 and horizontally impacted #38; food trap removed.
Tooth #47: Previously root-filled with periapical lesion and fractured distobuccal cusp; evidence of apical radiolucency and distal bone loss.
Periodontal and endodontic prognosis for #47 is guarded.
Tooth #28 indicated for extraction (XAP).
Missing #26 with proposed future implant site; sinus lift planned.
Treatment Plan
Surgical removal of impacted #38 under local anesthesia (completed).
Extraction (XAP) of #28 under local anesthesia (completed).
Scaling and polishing with review of pain at #37 and crack assessment of other teeth.
Consider crowning #36 and #47; possibly #37 if distal bone healing is favorable.
Possible extraction and implant placement at #47.
Sinus lift with augmentation at #26.
Implant placement at #26.
Regular recall and follow-up.
Pre-operative Assessment
CBCT scan showed horizontally impacted #38 with associated deep periodontal pocket distal to #37.
Deep bone loss noted distal to #47 with apical pathology and failed root canal treatment.
Risk of paraesthesia (lower lip and tongue) and oroantral communication discussed.
Informed consent obtained for stepwise treatment approach starting with removal of #38 and XAP of #28.
Anesthesia
Left-sided IDN, LN, and LBN blocks administered.
Infiltration anesthesia at #28.
Surgical Procedure
#38 (Impacted Wisdom Tooth Removal):
Area cleaned and draped.
Buccal flap raised with incision.
Bone guttering and tooth sectioning performed.
#38 removed in 10 pieces.
Socket curetted and irrigated with saline.
5 sutures placed using 6/0 Surgipro polypropylene for primary closure.
Hemostasis achieved.
#28 (Extraction):
Irrigated with saline post-extraction.
2 sutures placed using 6/0 Surgipro polypropylene for secondary closure.
Hemostasis achieved.
Post-operative Assessment
Post-op CBCT confirmed complete removal of #38 with no retained fragments.
Inferior dental nerve and maxillary sinus remained intact and uninvolved.
Patient tolerated the procedure well.
Instructions provided; follow-up scheduled.