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Surgical Removal of a Completely Buried Impacted Lower Left Wisdom Tooth (#38)

Surgical Procedure

Chief Complaint

Patient presented with pain and swelling associated with the lower left wisdom tooth (#38) and requested surgical removal.

Clinical Findings

  • Completely buried, bony impacted lower left wisdom tooth (#38).

  • Clinical symptoms of pain and swelling.

  • Pre-operative CBCT performed to assess the position of the tooth and its relationship to the Inferior Dental Nerve (IDN).

Treatment Plan

  • Surgical removal of impacted tooth #38 under local anaesthesia.

  • Bone removal and tooth sectioning as required.

  • Post-operative CBCT to confirm complete removal and assess adjacent anatomical structures.

Pre-operative Assessment

Pre-operative CBCT was reviewed to evaluate the position of the impacted tooth and its proximity to the Inferior Dental Nerve.

The patient was informed of:

  • The surgical procedure.

  • Risk of temporary or permanent altered sensation (paraesthesia) affecting the lower lip and tongue.

  • General surgical risks and expected healing process.

The patient understood the procedure, had all questions answered, and provided informed consent.

Anesthesia

  • Left Inferior Dental Nerve Block (IDN)

  • Lingual Nerve Block (LN)

  • Long Buccal Nerve Block (LBN)

Surgical Procedure

The patient was cleaned and draped under sterile protocol.

  • Buccal incision made and full-thickness flap elevated.

  • Bone guttering performed to expose the impacted tooth.

  • Tooth sectioned to facilitate removal.

  • Impacted tooth #38 removed in four sections.

  • Granulation tissue thoroughly curetted from the socket.

  • Surgical site irrigated with sterile saline.

  • Five interrupted sutures placed to achieve primary closure.

  • Haemostasis achieved.

A post-operative CBCT confirmed:

  • Complete removal of the impacted tooth.

  • No retained tooth fragments.

  • Inferior Dental Nerve remained intact and was not involved during surgery.

Post-operative Assessment

  • Surgical site achieved satisfactory haemostasis.

  • Complete tooth removal confirmed radiographically.

  • Inferior Dental Nerve remained intact.

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

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