Surgical Removal of a Grossly Carious Horizontally Impacted Lower Wisdom Tooth (#38) with Upper Wisdom Tooth Extraction (#28)
Surgical Procedure
Chief Complaint
Patient presented with pain and swelling associated with the lower left wisdom tooth (#38) and requested removal of both wisdom teeth (#38 and #28).
Clinical Findings
Tooth #38:
Grossly carious, horizontally impacted.
Very tender to percussion and palpation.
Normal mobility and periodontal probing depths.
Tooth #28 indicated for extraction.
Pre-operative CBCT reviewed to assess the relationship of the impacted lower wisdom tooth to the Inferior Dental Nerve (IDN) and surrounding anatomical structures.
Treatment Plan
Surgical removal of grossly carious, horizontally impacted tooth #38 under local anaesthesia.
Simple extraction of tooth #28.
Pre- and post-operative CBCT imaging.
Standard post-operative review and care instructions.
Pre-operative Assessment
Pre-operative CBCT was reviewed to evaluate the position of the impacted wisdom tooth and adjacent anatomical structures.
The patient was informed of:
The surgical procedure.
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) associated with upper wisdom tooth extraction.
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.
Tooth sectioned to facilitate removal.
Grossly carious horizontally impacted tooth removed in multiple sections.
Socket thoroughly curetted and irrigated with sterile saline.
Three interrupted sutures placed to achieve primary closure.
Haemostasis confirmed.
Tooth #28
Tooth extracted under local anaesthesia.
Socket irrigated with sterile saline.
Haemostasis achieved.
A post-operative CBCT confirmed:
Complete removal of both teeth.
No retained tooth fragments.
Inferior Dental Nerve remained intact.
Maxillary sinus remained uninvolved.
Post-operative Assessment
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.