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Surgical Removal of #37, #38

Surgical Removal

Chief Complaint

The patient reports severe pain in tooth #37, which has caries extending to the pulp. The patient also requests the removal of tooth #38, which is deeply impacted.

Clinical Findings

  • Tooth #37 has caries to the pulp with extensive decay and thin surrounding walls.

  • Very long, thin roots observed.

  • Slight metallic sound on percussion.

  • Bone is dense.

  • Deeply impacted tooth #38 with long roots noted on OPG.

Treatment Plan

  • XAP of tooth #37.

  • Surgical removal of retained roots if necessary.

  • Surgical removal of impacted tooth #38 if extraction of #37 is required.

  • Consideration for implant or bridge to replace the missing tooth or leave the space empty.

Pre-operative Assessment

Pre-operative CBCT was reviewed, and the IDN was plotted. Risks of paraesthesia to the lower lip and tongue, as well as potential IDN injuries, were discussed with the patient.

Anesthesia

  • Local anesthesia block was administered to the left IDN, LN, and LBN.

  • Local anesthesia XAP was performed for #37.

Surgical Procedure

  1. The patient was cleaned and draped.

  2. An incision was made, and a buccal flap was raised.

  3. Bone guttering and tooth sectioning were performed.

  4. Tooth #37 was elevated in 09 pieces.

  5. Curettage and irrigation with saline were done.

  6. Tooth #38 was deeply embedded and horizontally impacted, elevated in 11 pieces.

  7. Bone guttering and tooth sectioning for #38 were carried out.

  8. BSS x 06 was placed for primary closure.

  9. Haemostasis was achieved.

Post-operative Assessment

  • Post-operative CBCT was taken.

  • No tooth remnants were noted. The IDN and adjacent teeth were intact and not involved in the surgery.

  • The patient was reassured and provided with post-operative care instructions.

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