Surgical Removal of a Deep Mesially Impacted Lower Wisdom Tooth (#38) with Upper Wisdom Tooth Extraction (#28)

Surgical Removal

Chief Complaint

Patient reported food trapping, a “black hole” sensation, pain and swelling around #38.

Clinical Findings

Tooth #38 was deeply mesially impacted.
CBCT showed the roots compressing the Inferior Dental Nerve against the lingual cortical plate.
Tooth #28 was also indicated for extraction.

Treatment Plan

CBCT-guided surgical removal of #38.
Extraction of #28.
Post-operative imaging to confirm complete removal.

Pre-operative Assessment

Because of the close nerve relationship, the significantly increased risk of temporary or permanent altered sensation was discussed in detail. The risk of oro-antral communication for #28 was also explained. The patient understood and consented.

Anesthesia

Left Inferior Dental Nerve Block (IDN).
Lingual Nerve Block (LN).
Long Buccal Nerve Block (LBN).
Local anaesthesia at #28.

Surgical Procedure

A flap was raised and bone guttering performed around #38.
#38 was sectioned and removed in thirteen pieces.
Three sutures were placed.
#28 was extracted under local anaesthesia.
Post-operative CBCT confirmed complete removal with the IDN and maxillary sinus intact.

Post-operative Assessment

Complete removal was confirmed radiographically.
The Inferior Dental Nerve and maxillary sinus remained intact.
Post-operative instructions were provided.