Surgical Removal of Horizontally Impacted #48 with Concurrent Extraction of #18
Surgical Procedure
Chief Complaint
Patient requested removal of tooth #48.
Clinical Findings
#48 horizontally impacted.
Pre-op CBCT shows resorption of the distal root of #47 adjacent to the impacted #48.
#18 indicated for removal (XAP).
No signs of infection or swelling; pain minimal but patient elects for removal.
Treatment Plan
LA OP surgical removal of horizontally impacted #48.
LA XAP of #18.
All risks, benefits, alternatives explained—including:
Risk of paraesthesia to lower lip and tongue
Risk of OAP/OAF
Patient understood and agreed to proceed.
Informed consent obtained.
Pre-operative Assessment
Pre-op CBCT reviewed:
#48 horizontal impaction
Distal root resorption adjacent
IDN intact and in close proximity but not encased
Maxillary sinus normal
Medical history reviewed; patient suitable for procedure.
Anesthesia
LA block: Left IDN, LN, LBN
Additional LA infiltration at #18
Surgical Procedure
Patient cleaned and draped.
Incision made; buccal flap raised.
Bone guttering performed to access impaction.
Tooth #48 sectioned.
#48 elevated and removed in three pieces.
Curettage of socket; saline irrigation.
BSS × 07 placed for primary closure.
Hemostasis achieved; POI given.
#18 Extraction:
LA XAP #18 performed.
Irrigation with saline.
Hemostasis achieved; POI given.
Post-operative Assessment
Post-op CBCT taken.
No retained fragments.
IDN intact and uninvolved.
Maxillary sinus clear and not affected.
Wound edges well approximated.
Patient reassured and satisfied with outcome.