Surgical Removal of a Very Deep Horizontally Impacted Lower Wisdom Tooth (#48)
Surgical Procedure
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Chief Complaint
Patient presented with pain and swelling associated with the lower right wisdom tooth (#48) and requested surgical removal.
Clinical Findings
Tooth #48: very deep horizontally impacted lower wisdom tooth.
Symptomatic with pain and swelling.
Pre-operative CBCT reviewed to assess the position of the impacted tooth and its relationship to surrounding anatomical structures.
Bone grafting following extraction was discussed due to the anticipated size of the surgical defect; however, the patient declined grafting.
Treatment Plan
CBCT-guided surgical removal of impacted tooth #48 under local anaesthesia.
Thorough debridement of the extraction socket.
Primary wound closure.
Standard post-operative care and review.
Pre-operative Assessment
Pre-operative CBCT was reviewed to evaluate the depth of impaction and surrounding anatomy.
The patient was informed of:
The surgical procedure.
Risk of temporary or permanent altered sensation (paraesthesia) affecting the lower lip and tongue.
Possible need for bone grafting because of the extensive surgical defect following removal.
Bone grafting was discussed, but the patient elected not to proceed. The patient’s preference was respected.
The patient understood the treatment plan and provided informed consent.
Anesthesia
Right 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 controlled removal.
Very deeply impacted wisdom tooth removed in twelve sections.
Extraction socket thoroughly curetted and irrigated with sterile saline.
Four interrupted sutures placed to achieve primary closure.
Haemostasis confirmed.
Post-operative Assessment
Surgical site achieved satisfactory haemostasis.
Complete removal of the impacted tooth was confirmed clinically.
Patient was reassured and provided with comprehensive post-operative care instructions.
A medical certificate for five days was issued to facilitate recovery following the extensive surgical procedure.