Surgical Removal of Impacted #38 and Extraction of #28
Surgical Removal
Chief Complaint
Patient complained of pain on the left-hand side that had worsened to the point where she required painkillers.
Clinical Findings
Tooth #28 was over-erupted and biting on the cheek and gum overlying the area of #38.
Tooth #38 was not clinically visible.
Treatment Plan
Extraction of #28 (XAP #28)
Surgical removal of impacted #38 (LAOP #38)
Patient advised regarding the risk of paresthesia involving the lower lip and tongue.
Procedures explained; patient understood and consented to proceed.
Pre-operative Assessment
No signs of active infection.
Patient in good general health.
CBCT and radiographic evaluation indicated #38 impaction close to the inferior dental canal, with no sinus involvement.
Anesthesia
Topical anesthesia applied.
3 × Scandonest 2% Mepivacaine via ID block, long buccal, and buccal infiltration for #38.
1 × Scandonest 2% Mepivacaine via buccal and palatal infiltration for #28.
Surgical Procedure
Patient cleaned and draped under aseptic conditions.
Buccal incision made and flap raised at #38 region.
Bone guttering performed.
Tooth #38 sectioned and elevated in three pieces.
Curettage and irrigation with saline.
BSS × 05 placed for primary closure.
Haemostasis achieved; post-operative instructions given.
Extraction of #28 performed under local anesthesia.
Socket irrigated with saline.
Haemostasis achieved; post-operative instructions given.
Post-operative Assessment
Post-operative CBCT taken — no residual tooth fragments noted.
Inferior dental nerve (IDN) and maxillary sinus both intact and uninvolved.
Patient reassured and discharged in stable condition.