Surgical removal of Horizontal to inverted impaction of #38
Surgical Removal
Chief Complaint
Patient presented with complaint of persistent oral odour and reported frequent use of mouthwash and deodorizer. Patient also noted pain and swelling in the lower left posterior region.
Clinical Findings
Presence of large twin venting fistulas with pus exudate on the buccal aspect of the impacted tooth #38.
Tooth #38 not visible intra-orally.
Treatment Plan
Pre-operative Assessment
Radiographic Findings (CBCT):
Horizontal to inverted impaction of #38.
Presence of an 11 mm dentigerous infected cyst surrounding the occlusal surface of #38.
Tooth #38 distalized by cystic lesion.
Risks of paresthesia to the lower lip and tongue were explained. The procedure, risks, and benefits were discussed. Patient understood and provided informed consent.
Anesthesia
Local anesthesia: Left inferior dental nerve (IDN), lingual nerve (LN), and long buccal nerve (LBN) blocks administered.
Surgical Procedure
Patient cleaned, draped, and prepared for surgery.
Incision made and buccal flap raised.
Bone guttering performed to access tooth.
Tooth sectioned; #38 elevated in three pieces.
Thorough curettage and irrigation with saline.
Placement of BSS × 05 for primary closure.
Achieved hemostasis.
Delivered post-operative instructions (POI).
Post-operative Assessment
Radiographic Review (CBCT):
Inferior dental nerve not involved during surgery.
Tooth #38 fully removed.
Distal bone of tooth #37 spared and preserved.
Patient reassured and advised on follow-up care.