Surgical Removal of Impacted #38
Surgical Removal
Chief Complaint
Pain on distal of #37, partially erupted and impacted #38 with pericoronitis.
Clinical Findings
Partial eruption and impaction of #38
Mild trismus noted
Pre-operative CBCT shows #38 is distolingually tilted and impacted with a bony coronoid
IDN plotted lingual to #38 roots and passes between the roots
Curved roots of #38
Risk of IDN injury and paresthesia to lower left lip, chin, and tongue explained to the patient
Treatment Plan
Advised removal of partially erupted and impacted #38 under local anesthesia.
Pre-operative Assessment
Patient agreeable to the procedure
Informed of risks including potential IDN injury and paresthesia
Patient understood and consented to proceed
Anesthesia
LA block administered to IDN, LN, and LBN on the left side
Surgical Procedure
Patient cleaned and draped
Buccal flap raised after incision
Bone guttering and tooth sectioning performed
#38 elevated out in four pieces
Curettage and irrigation with saline
Six BSS placed for primary closure
Hemostasis achieved and post-operative instructions provided
Post-operative Assessment
Post-OP CBCT taken
IDN spared, no tooth remnants noted
Patient shown CBCT and reassured