Surgical Removal of Impacted #38
Surgical Procedure
Chief Complaint
Pain and swelling associated with lower left posterior region.
Clinical Findings
Tooth #38:
NTTP, very TTPp
Mobility WNL
Surrounding gingiva swollen and erythematous
No pus expressed after recent antibiotics
Deep horizontal impaction
CBCT showed #38 in close proximity to the inferior dental nerve (IDN)
Diagnosis: Impacted wisdom tooth with local inflammation.
Treatment Plan
LA oral surgery for removal of impacted #38
Extraction of #28 under LA (XAP)
Curettage, irrigation, and primary closure
Post-operative CBCT to confirm complete removal
Pre-operative Assessment
Pre-op CBCT reviewed with patient
Risks explained, including paresthesia to lower lip and tongue
Procedure and steps discussed
Patient understood and agreed
Informed consent obtained for LA OP removal of #38 and XAP #28
Anesthesia
Left IDN, LN, and LBN block.
Surgical Procedure
Patient cleaned and draped
Incision made; buccal flap raised
Bone guttering performed
Tooth sectioning
#38 elevated out in 3 pieces
Curettage and saline irrigation
BSS × 4 placed for primary closure
Hemostasis achieved
Post-operative instructions provided
Post-operative Assessment
Post-op CBCT confirmed complete removal with no remnants
IDN visualised as intact and uninvolved
Patient reassured and discharged in stable condition