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Surgical Removal of a Deep Horizontally Impacted Lower Wisdom Tooth (#38) and Retained Upper Wisdom Tooth Roots (#28)

Surgical Procedure

Chief Complaint

Patient presented with pain and swelling associated with the upper left wisdom tooth (#28) and requested removal of both the upper and lower left wisdom teeth.

Clinical Findings

  • Tooth #38

    • Deep horizontally impacted lower wisdom tooth.

    • Approximately one-quarter of the crown visible intra-orally.

  • Tooth #28

    • Grossly carious.

    • Retained roots requiring surgical removal.

  • Pre-operative CBCT reviewed to evaluate the relationship of the impacted lower wisdom tooth to the Inferior Dental Nerve (IDN) and the retained upper roots to the maxillary sinus.

Treatment Plan

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

  • Surgical removal of retained roots of tooth #28.

  • Pre- and post-operative CBCT imaging.

  • Standard post-operative care and review.

Pre-operative Assessment

Pre-operative CBCT was reviewed to assess the position of the impacted wisdom tooth and retained roots relative to adjacent anatomical structures.

The patient was informed of:

  • The planned surgical procedures.

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

  • Risk of oro-antral communication (OAC) or oro-antral fistula (OAF) during removal of the upper retained roots.

  • Expected healing process and possible complications.

The patient understood the treatment plan and provided informed consent.

Anesthesia

  • Left Inferior Dental Nerve Block (IDN)

  • Lingual Nerve Block (LN)

  • Long Buccal Nerve Block (LBN)

  • Local infiltration for tooth #28

Surgical Procedure

Tooth #38

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.

  • Deep horizontally impacted tooth removed in multiple sections.

  • Socket curetted and irrigated thoroughly with sterile saline.

  • Three interrupted sutures placed to achieve primary closure.

  • Haemostasis confirmed.

Tooth #28

  • Buccal incision made and full-thickness flap elevated.

  • Bone guttering performed to expose the retained roots.

  • Retained roots sectioned and removed in two pieces.

  • Socket curetted and irrigated thoroughly with sterile saline.

  • Two interrupted sutures placed to achieve primary closure.

  • Haemostasis confirmed.

A post-operative CBCT confirmed:

  • Complete removal of both teeth and retained roots.

  • No retained tooth fragments.

  • Inferior Dental Nerve remained intact.

  • Maxillary sinus remained uninvolved.

Post-operative Assessment

  • Both surgical sites achieved satisfactory haemostasis.

  • Complete removal confirmed radiographically.

  • Inferior Dental Nerve and maxillary sinus remained intact.

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

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