Surgical Removal of Impacted #45 Under Local Anesthesia
Surgical Removal
Chief Complaint
Px complained of worsening pain at lower right molar region over the past 1 week.
Clinical Findings
#47 and #48 missing
Large recent TCR restoration present on #46
Px initially suspected pain originating from #46
#46 and #44
Asymptomatic
Very slight TTP and TTPp
Mobility and probing depth WNL
Bite test negative
#45
Tightly mesially impacted against #44
Very TTP and TTPp
Mobility I++
Probing depth increased approximately 5–7mm
OPG taken following discussion and consent for radiographic investigation.
Radiographic findings for #45:
DO TCR extending close to pulp
PA lesion with widened periapical PDL spaces
Approximately 50% surrounding bone loss
Tightly mesially impacted against #44
Additional finding:
Impacted and buried #25 noted incidentally
Treatment Plan
Surgical removal of impacted #45 under local anesthesia
Risks, benefits, procedures, and post-operative expectations explained to Px.
Pre-operative Assessment
Clinical and radiographic assessments performed prior to surgery.
Impacted #45 associated with periodontal destruction, mobility, and periapical pathology.
Risks including paraesthesia to lower lip and tongue, swelling, bleeding, infection, adjacent tooth damage, retained fragments, and post-operative discomfort discussed.
Px understood and agreed to proceed.
Informed consent obtained.
Anesthesia
LA block administered to right IDN, LN, and LBN.
Surgical Procedure
Px cleaned and draped in sterile manner.
Incision made and buccal flap raised.
Bone guttering performed.
Tooth sectioning carried out.
#45 elevated and removed in 9 pieces.
Socket curettage performed and irrigated thoroughly with saline.
BSS x3 placed for secondary closure.
Haemostasis achieved.
POI given.
Post-operative Assessment
Post-operative OPG taken.
No retained tooth remnants noted.
IDN and adjacent teeth not involved during surgery.
Healing satisfactory post-operatively.
Px reassured and discharged in stable condition.