Surgical Removal of Horizontally Impacted #38 and #28 under Local Anesthesia
Surgical Removal
Chief Complaint
Patient presented with pain and swelling in the lower left posterior region and requested removal of tooth #38.
Clinical Findings
Horizontally impacted lower left third molar (#38).
Associated pain and swelling.
Pre-operative CBCT taken for assessment.
Upper left third molar (#28) also indicated for removal.
Treatment Plan
Surgical removal of tooth #38 under local anesthesia.
Surgical removal of tooth #28 under local anesthesia.
Risks including paraesthesia of the lower lip and tongue, as well as oro-antral communication, were explained.
Procedures discussed; patient understood and agreed.
Informed consent obtained.
Pre-operative Assessment
CBCT reviewed; no contraindications for local anesthesia.
Patient stable for surgery.
Anesthesia
Left inferior dental nerve block, lingual nerve block, and long buccal nerve block for #38.
Local infiltration for #28.
Surgical Procedure
Tooth #38
Patient cleaned and draped.
Incision made and buccal flap raised.
Bone guttering performed.
Tooth sectioned and removed in 10 pieces.
Curettage and irrigation with saline.
Closure achieved with 4 interrupted sutures (BSS).
Hemostasis secured.
Tooth #28
Local flap access.
Tooth removed and site irrigated with saline.
Hemostasis achieved.
Post-operative Assessment
Post-operative CBCT confirmed no tooth remnants.
Inferior dental nerve and maxillary sinus intact and uninvolved.
Patient reassured and provided post-operative instructions.