Surgical Removal of Deep Horizontally Impacted Lower Right Wisdom Tooth (#48) with Extraction of Upper Right Wisdom Tooth (#18)
Surgical Removal
Chief Complaint
Patient complained of pain and persistent food trapping around the lower right posterior region and requested removal of tooth #48.
Clinical Findings
Clinical and CBCT evaluation revealed:
Deep horizontally impacted #48
Gross distal-occlusal-lingual caries on #48
Distal caries on #47
Distal caries on #37
Impacted #38
Food impaction associated with #48
No involvement of inferior dental nerve or maxillary sinus noted on imaging.
Treatment Plan
Planned procedures:
LA surgical removal of impacted #48
LA extraction of #18
Post-operative CBCT verification
Risks including lower lip and tongue paraesthesia and OAP/OAF explained.
Patient understood and agreed to proceed.
Informed consent obtained.
Pre-operative Assessment
Pre-operative CBCT taken to assess:
Depth and angulation of impaction
Proximity to inferior dental nerve
Root morphology
Surrounding anatomical structures
No nerve involvement detected.
Surgical removal planned under local anesthesia.
Anesthesia
Local anesthesia administered:
Left IDN block
Lingual nerve block
Long buccal nerve block
Additional infiltration at #48
Adequate anesthesia achieved prior to procedure.
Surgical Procedure
Patient cleaned and draped in sterile manner.
For #48:
Incision made
Buccal flap raised
Bone guttering performed
Tooth sectioning completed
Tooth elevated and removed
Socket management:
Curettage performed
Irrigation with saline
Primary closure achieved
Hemostasis secured
For #18:
Local extraction performed
Irrigation with saline
Hemostasis achieved
Post-operative CBCT taken.
Findings confirmed:
No retained tooth fragments
Inferior dental nerve intact
Maxillary sinus intact and not involved
Post-operative instructions given.
Post-operative Assessment
Surgical removal completed successfully.
No complications observed intra-operatively.
Radiographic confirmation showed:
Complete removal of tooth structures
No nerve involvement
No sinus involvement
Patient reassured and discharged in stable condition.