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Surgical Removal of Horizontally Impacted Lower Wisdom Tooth (#48) Near Nerve

Surgical Removal

Chief Complaint

Patient presented with recurrent pain and swelling at the lower right posterior region over multiple episodes in the past year. Requested removal of wisdom tooth.

Clinical Findings

  • Tooth #48: Horizontally impacted

  • History of recurrent pericoronitis

  • CBCT findings:

    • #48 in close proximity to Inferior Dental Nerve (IDN)

    • #38 also noted near IDN

  • Tooth #18 indicated for extraction

Treatment Plan

  • Surgical removal of impacted tooth #48 under local anaesthesia

  • Simple extraction of tooth #18

Pre-operative Assessment

  • CBCT reviewed prior to surgery

  • High-risk case due to proximity to IDN

  • Risks explained:

    • Paraesthesia (lower lip and tongue)

    • Oroantral communication / fistula (OAP/OAF)

  • Procedures explained in detail

  • Patient and guardian understood and consented

Anesthesia

  • Right Inferior Dental Nerve (IDN), Lingual Nerve (LN), Long Buccal Nerve (LBN) block

  • Local infiltration for tooth #18

Surgical Procedure

Tooth #48 (Impacted Wisdom Tooth Surgery)

  • Patient cleaned and draped

  • Incision made and buccal flap raised

  • Bone guttering performed

  • Tooth sectioned

  • Tooth removed in multiple segments

  • Curettage performed

  • Irrigation with saline

  • Sutured with resorbable sutures (BSS x4)

  • Hemostasis achieved

Tooth #18 (Extraction)

  • Tooth elevated and removed

  • Irrigation performed

Hemostasis achieved

Post-operative Assessment

  • Post-operative CBCT confirms:

    • No retained root fragments

    • Inferior Dental Nerve intact

    • Maxillary sinus not involved

  • Patient stable and reassured

  • No medical leave required

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