Surgical Removal for Tooth #37
Surgical Removal
Extraction
Chief Complaint
Patient complains of pain in the third quadrant.
Clinical Findings
Tooth #37 impacted against tooth #36 mesially.
Tooth #37: Very tender to percussion (TTP), non-tender to palpation (NTTPp), mobility within normal limits (WNL), deep distal probing depth with pus exudate, possible mesial caries.
Tooth #36: Slightly tender to percussion (STTP), non-tender to palpation (NTTP), mobility and periodontal depth WNL, possible distal caries.
Periapical (PA) radiograph taken.
Treatment Plan
Extraction (XAP) of tooth #37 with possible local anesthesia oral surgery (LAOP) removal if complicated, and LAOP removal of tooth #38.
LAOP of tooth #38, periodontal treatment, and restoration (CAP) of tooth #37, with potential root canal treatment (RCT) if symptoms or caries reach the pulp.
Pre-operative Assessment
Tooth #37 has a guarded periodontal prognosis due to deep distal pocketing and approximately 60% bone loss.
Patient expressed preference for extraction of tooth #37 and to retain tooth #38, avoiding surgery.
Pre-operative CBCT scan taken showing:
Invertedly impacted tooth #48.
Impacted teeth #37 and #38.
Inferior dental nerve (IDN) plotted.
Anesthesia
Local anesthesia (LA) administered and increased for surgical procedure.
Surgical Procedure
Patient cleaned and draped.
Incision made, and buccal flap raised.
Bone guttering performed.
Tooth sectioning carried out.
Tooth #37 elevated out in six pieces.
Currettage performed, and site irrigated with saline.
Six 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
Tooth #37 has a guarded periodontal prognosis due to deep distal pocketing and approximately 60% bone loss.
Patient expressed preference for extraction of tooth #37 and to retain tooth #38, avoiding surgery.
Pre-operative CBCT scan taken showing:
Invertedly impacted tooth #48.
Impacted teeth #37 and #38.
Inferior dental nerve (IDN) plotted.