Surgical Removal for Impacted Tooth #38
Surgical Removal
Impacted Wisdom Tooth
Chief Complaint
Patient complains of pain in the third quadrant.
Clinical Findings
Tooth #38 impacted and grossly carious, very tender to percussion (TTP) and palpation (TTPp), mobility and periodontal depth within normal limits (WNL).
Tooth #37 slightly tender to percussion (STTP), non-tender to palpation (NTTPp), mobility and periodontal depth WNL, possible distal caries.
Treatment Plan
CBCT scan for detailed assessment.
Treatment of potential distal caries on tooth #37 with crown (CAP) or root canal treatment (RCT) and surgical removal (LAOP) of tooth #38.
Scaling and root planing (SRP) and follow-up (C/UP).
Regular recall for maintenance.
Pre-operative Assessment
Pre-operative CBCT scan taken, revealing impacted tooth #38 with caries extending to the pulp.
Additional findings: caries on #15 (distal occlusal), #16 (mesial distal), #25 (distal), #26 (mesial), #36 (distal), #37 (mesial distal), #46 (distal occlusal).
Patient advised on the necessary treatments, including:
LAOP removal of impacted and carious tooth #38.
CAP for tooth #37 (distal occlusal) and tooth #15 (distal occlusal), with possible RCT for tooth #15.
SRP and follow-up.
CAP for other affected teeth as needed.
Risks of parasthesia to lower lip and tongue, and oral-antral perforation (OAP)/oral-antral fistula (OAF) discussed.
Patient understood and agreed to the procedures, with informed consent taken.
Anesthesia
Local anesthesia (LA) administered: inferior dental nerve (IDN) block, lingual nerve (LN) block, and long buccal nerve (LBN) block.
Chlorhexidine mouthwash rinse before surgery.
Surgical Procedure
Patient cleaned and draped.
Incision made and buccal flap raised.
Bone guttering performed.
Tooth #38 sectioned and elevated out in two pieces.
Currettage performed and site irrigated with saline.
Four bone substitute materials (BSS) placed for primary closure.
Hemostasis achieved, and post-operative instructions (POI) provided.
Post Operation Gallery
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Post-operative Assessment
Pre-operative CBCT scan taken, revealing impacted tooth #38 with caries extending to the pulp.
Additional findings: caries on #15 (distal occlusal), #16 (mesial distal), #25 (distal), #26 (mesial), #36 (distal), #37 (mesial distal), #46 (distal occlusal).
Patient advised on the necessary treatments, including:
LAOP removal of impacted and carious tooth #38.
CAP for tooth #37 (distal occlusal) and tooth #15 (distal occlusal), with possible RCT for tooth #15.
SRP and follow-up.
CAP for other affected teeth as needed.
Risks of parasthesia to lower lip and tongue, and oral-antral perforation (OAP)/oral-antral fistula (OAF) discussed.
Patient understood and agreed to the procedures, with informed consent taken.