Surgical Removal of Impacted #38 and Routine Extraction of #28 with Post-RCT #35
Surgical Removal
Chief Complaint
Patient referred by Dr. TXX for continued management of teeth #35, #37, and #38.
Endodontic retreatment on #35 completed by Dr. TXX
Symptoms resolved; prognosis deemed good for crown restoration
No symptoms reported on #35, #37, or #38
Clinical Findings
#38: Partially buried in bone; impacted
#37: Deep distal caries noted
#35: Root canal retreatment completed, metal band present and cemented
Treatment Plan
Surgical extraction of #38 under local anesthesia
Extraction of #28 under local anesthesia (XAP)
Pre-operative Assessment
Pre-op CBCT taken
Patient advised of the treatment plan including risks:
Paresthesia of the lower lip and tongue
Oroantral communication (OAC/OAF)
Procedures and risks explained in detail
Patient understood and agreed to proceed
Informed consent obtained
Anesthesia
Local anesthetic administered:
Left Inferior Dental Nerve (IDN) block
Lingual Nerve (LN) block
Long Buccal Nerve (LBN) block
Infiltration anesthesia at #28
Surgical Procedure
#38 – Surgical Extraction:
Patient cleaned and draped
Incision made; buccal flap raised
Bone guttering performed to access the tooth
Tooth sectioned and removed in 12 pieces
Socket curettaged and irrigated with saline
Three BSS placed for primary closure
Hemostasis achieved
Post-operative instructions (POI) given
#28 – Extraction (LA XAP):
Extraction performed under LA
Site irrigated with saline
Hemostasis achieved
POI given
Post-operative Assessment
Post-operative CBCT taken
No remaining tooth fragments identified
Inferior dental nerve and maxillary sinus intact and uninvolved in surgery
Patient reassured