Surgical Removal of Impacted #38 and Retained Roots of #37
Surgical Procedure
Chief Complaint
Pain and swelling associated with lower left posterior teeth (#37 and #38).
Clinical Findings
Tooth #38:
Horizontally impacted
Associated with pain and swelling
CBCT confirmed impaction and proximity to IDN
Tooth #37:
Patient initially requested simple extraction
Coronal fracture occurred during gentle forcep extraction
Firm retained roots
Roots long, thin, wide/flattened
Unable to elevate normally → surgical removal required
Treatment Plan
LA OP removal of horizontally impacted #38
LA OP surgical removal of retained roots of #37
Curettage and irrigation of both sites
Primary closure with sutures
Post-op CBCT to confirm full clearance
Patient declined RCT+PC+Crown for #37 and opted for extraction only.
Pre-operative Assessment
Risks explained, including paresthesia to lower lip and tongue
Procedure steps discussed in detail
CBCT reviewed prior to removal of #37 retained roots and #38
Patient understood treatment limitations and agreed
Informed consent obtained for surgical removal of #38 and retained roots of #37
Anesthesia
Left IDN, LN, and LBN block.
Surgical Procedure
Tooth #37 – Retained Roots
Patient cleaned and draped
Incision; buccal flap raised
Bone guttering
Sectioning of retained roots
#37 elevated in 9 pieces
Curettage and saline irrigation
Tooth #38 – Horizontally Impacted
Bone guttering
Tooth sectioning
#38 elevated in 12 pieces
Curettage and saline irrigation
BSS × 6 placed for primary closure.
Hemostasis achieved; POI given.
Post-operative Assessment
Post-op CBCT confirmed no remnants for both #37 and #38
IDN intact; no involvement
Adjacent teeth unaffected
Patient reassured and discharged in stable condition