Surgical Removal of #38 with Bone Grafting for #37
Surgical Removal
Chief Complaint
Patient complains of pain and swelling and requests the removal of tooth #38.
Clinical Findings
Tooth #38 is buried completely in bone and deeply horizontally impacted.
Treatment Plan
Removal of impacted tooth #38 under local anesthesia.
Pre-operative CBCT reviewed, and the patient agrees to proceed with the treatment.
Pre-operative Assessment
Patient informed of the risks of paresthesia to the lower lip and tongue.
The procedure was explained, and the patient understood and agreed to proceed.
Informed consent was obtained.
Anesthesia
Local anesthesia administered: left inferior dental nerve (IDN), lingual nerve (LN), and long buccal nerve (LBN) block.
Surgical Procedure
Patient cleaned and draped.
Incision made, buccal flap raised.
Bone guttering performed.
Tooth #38 sectioned and elevated in 6 pieces.
Missing distal root suspected; unable to locate intraorally.
Intra-operative CBCT taken to ascertain the distal root's position and orientation.
Distal root of #38 located, and the patient was draped again for retained root removal.
Tooth #38 fully elevated in a total of 7 pieces.
Curettage performed, with granulation tissue completely removed.
Irrigation with saline conducted.
Bone grafting done to ensure bone coverage on the exposed distal surface of tooth #37.
EthOss 1.0cc packed onto the distal root surface of #37 and into root sockets.
Dentium Osteon collagen II placed centrally to compact the bone graft and fill the defect.
Seven BSS (Bone Spongiosa Substitute) placed for primary closure.
Haemostasis achieved, and post-operative instructions given.
Post-operative Assessment
Post-operative CBCT taken; no tooth remnants noted.
Inferior dental nerve (IDN) not involved in the surgery.
Bone graft is dense and stable.