Surgical Removal of Buried and Impacted #48 and Impacted #18 Under Local Anesthesia
Surgical Procedure
Chief Complaint
Px complained of worsening pain and swelling at lower right posterior region for the past 2 weeks.
Clinical Findings
#48 buried and impacted, not visible intra-orally
Px c/o pain and swelling associated with #48 region
#47 perio-endo involved
#18 impacted
Pre-operative CBCT reviewed.
#18 and #48 impactions assessed.
Treatment Plan
Surgical removal of impacted #48 under local anesthesia
Surgical removal of impacted #18 under local anesthesia
Extraction of #47
Risks, benefits, procedures, and post-operative expectations explained to Px
Pre-operative Assessment
CBCT reviewed prior to surgery.
Relationship of impacted teeth to adjacent anatomical structures assessed.
Risks of paraesthesia to lower lip and tongue, OAP/OAF, bleeding, swelling, infection, retained roots, and post-operative discomfort discussed.
Px understood and agreed to proceed.
Informed consent obtained.
Anesthesia
LA block administered to right IDN, LN, and LBN.
Additional LA infiltration administered at #18 region.
Surgical Procedure
Px cleaned and draped in sterile manner.
LA XAP #47 completed successfully.
Initial attempt at extraction of #48 performed; however, poor leverage and engagement prevented luxation.
Incision made and buccal flap raised.
Bone guttering performed.
Tooth sectioning carried out.
#48 elevated and removed in 2 pieces.
Socket curettage performed and irrigated thoroughly with saline.
BSS x5 placed for secondary closure.
Haemostasis achieved.
POI given.
Surgical removal of impacted #18 subsequently performed.
Incision made and buccal flap raised.
Bone guttering and tooth sectioning carried out.
#18 elevated and removed in 2 pieces.
Socket irrigated thoroughly with saline.
BSS x2 placed for secondary closure.
Haemostasis achieved.
POI given.
Post-operative Assessment
Post-operative CBCT taken.
No retained tooth remnants noted.
IDN and maxillary sinus intact and not involved during surgery.
Healing satisfactory post-operatively.
Px reassured and discharged in stable condition.