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Surgical Removal of Impacted #38, #28

Surgical Removal

Chief Complaint

The patient reports pain and swelling in the area of tooth #38 and requests its removal.

Clinical Findings

Tooth #38 is completely buried in bone and impacted.

Treatment Plan

Surgical removal of impacted tooth #38 and extraction of tooth #28.

Pre-operative Assessment

  • A pre-operative CBCT scan was taken to evaluate the impacted tooth and surrounding structures.

  • The patient was informed about the risks of paresthesia affecting the lower lip and tongue, as well as the possibility of oroantral or oronasal fistula (OAF/OAP).

  • The procedures and associated risks were explained in detail.

  • The patient understood and agreed to the treatment plan.

  • Informed consent was obtained.

Anesthesia

Local anesthesia (LA) block was administered to the left inferior dental nerve (IDN), lingual nerve (LN), and long buccal nerve (LBN), with additional LA infiltration for tooth #28.

Surgical Procedure

  1. The patient was cleaned and draped.

  2. An incision was made, and a buccal flap was raised.

  3. Bone guttering was performed, followed by tooth sectioning.

  4. Tooth #38 was elevated out in nine pieces.

  5. Curettage and irrigation with saline were carried out, and primary closure was achieved using BSS x 03, ensuring hemostasis and providing post-operative instructions (POI).

  6. The extraction of tooth #28 was completed with irrigation and hemostasis.

Post-operative Assessment

  • A post-operative CBCT scan revealed a retained distal root of tooth #38.

  • The inferior dental nerve (IDN) and maxillary sinus were intact and not involved in the surgery.

  • A further exploration was scheduled to remove the retained distal root.

  • Additional bone guttering was performed, and the retained distal root of tooth #38 was removed in two pieces, bringing the total to eleven pieces removed.

  • Another primary closure was achieved using BSS x 03.

Final Post Operative Assessment:

  • A second post-operative CBCT confirmed the complete removal of the retained distal root with no remaining tooth fragments.

  • The IDN and maxillary sinus were intact and not involved.

  • The patient was reassured and provided with further post-operative care instructions.

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