Surgical Removal of a Grossly Carious Horizontally Impacted Lower Wisdom Tooth with Upper Wisdom Tooth Extraction
Surgical Procedure
Chief Complaint
Patient presented with pain and swelling associated with the lower right wisdom tooth (#48) and requested removal of both #48 and the upper left wisdom tooth (#18).
Clinical Findings
Grossly carious, horizontally impacted tooth #48.
Carious and non-functional tooth #18.
Pre-operative CBCT was taken and reviewed to assess the relationship of #48 to the inferior dental nerve and surrounding anatomical structures.
Treatment Plan
Surgical removal of grossly carious, horizontally impacted tooth #48 under local anaesthesia.
Simple extraction of carious, non-functional tooth #18.
Pre- and post-operative CBCT imaging.
Post-operative review and standard surgical aftercare instructions.
Pre-operative Assessment
The patient was informed of:
Risk of temporary or permanent altered sensation (paraesthesia) affecting the lower lip, chin, and tongue.
Risk of oro-antral communication/oro-antral fistula associated with the upper wisdom tooth extraction.
Surgical procedures, expected healing, and possible complications.
The patient demonstrated understanding and provided informed consent to proceed.
Anesthesia
Inferior Dental Nerve Block (IDN)
Lingual Nerve Block (LN)
Long Buccal Nerve Block (LBN) for #48
Local infiltration for #18
Surgical Procedure
The patient was cleaned and draped under sterile protocol.
Tooth #48
Full-thickness buccal flap raised.
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.
Four interrupted sutures placed to obtain primary closure.
Haemostasis achieved.
Tooth #18
Simple extraction performed.
Socket curetted and irrigated with sterile saline.
Haemostasis achieved.
A post-operative CBCT confirmed:
No retained tooth fragments.
Inferior dental nerve remained intact.
Maxillary sinus was intact with no surgical involvement.
Post-operative Assessment
Surgical sites were stable with satisfactory haemostasis.
No retained roots or bony fragments detected.
Inferior dental nerve and maxillary sinus remained intact.
Patient was reassured and provided with post-operative care instructions.