Surgical Removal of Horizontally Impacted #38 with Extraction of #28
Surgical Removal
Chief Complaint
Patient reports pain and swelling associated with lower left wisdom tooth (#38). Requests removal.
Clinical Findings
Teeth #37 & #46 (Review)
Asymptomatic
NTTP, NTTPp
Mobility within normal limits
Probing depth within normal limits
Bite test: Positive on #37, inconclusive on #46
Tooth #38
Deep horizontal impaction
Associated pain and swelling
Treatment Plan
LA surgical removal of impacted #38
LA extraction of #28 (to prevent opposing gum irritation and maintain hygiene)
Post-operative CBCT to confirm no remnants and assess structures
Pre-operative Assessment
CBCT taken and reviewed
Risks explained: paraesthesia of lower lip and tongue, OAP/OAF
Procedure, benefits, and risks discussed
Patient understood and consented to proceed
Anesthesia
LA block: Left IDN, LN, LBN
LA infiltration at #28
Surgical Procedure
#38 Surgical Removal
Patient cleaned and draped
Incision made; buccal flap raised
Bone guttering performed
Tooth sectioned
#38 elevated in 6 pieces
Curettage and saline irrigation
BSS ×4 placed for primary closure
Hemostasis achieved; POI given
#28 Extraction
XAP performed
Irrigation with saline
Hemostasis; POI given
Post-operative Assessment
Post-op CBCT taken
No tooth remnants detected
IDN and maxillary sinus intact and not involved
Patient reassured and discharged with instructions