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Surgical Removal of Impacted #48

Surgical Removal

Chief Complaint

Patient reports pain and swelling associated with tooth #48.


Clinical Findings

  • Tooth #48: Horizontally impacted with caries and distal bone loss, possibly extending to the apex. Potential perio-endo involvement.

  • Tooth #47: Bone loss to the distal root apex with furcation involvement, class II to III, indicating a very poor periodontal prognosis.

  • Tooth #37: Distal bone loss to the root apex with furcation involvement, class III. Considered a hopeless tooth.

  • Tooth #38: Horizontally impacted.

Treatment Plan

The patient was advised to undergo the removal of teeth #48 and #38 and extraction of teeth #47 and #37 under local anesthesia. However, the patient opted to first remove only the painful tooth #48.

Pre-operative Assessment

A CBCT scan was taken to assess the impacted tooth and surrounding structures. The right inferior dental nerve (IDN) was plotted.


Anesthesia

Local anesthesia was administered, including a right inferior alveolar nerve (IDN) block, lingual nerve (LN) block, and long buccal nerve (LBN) block.

Surgical Procedure

  1. Patient cleaned and draped

  2. Incision made

  3. Buccal flap raised

  4. Bone guttering performed

  5. Tooth #48 sectioned and elevated out in two pieces

  6. Curettage performed and irrigated with saline

  7. Five bone suture splints (BSS) placed for primary closure

  8. Haemostasis achieved and post-operative instructions (POI) provided

Post-operative Assessment

A post-operative CBCT scan confirmed no involvement of the IDN and no remnants of the tooth. The patient was reassured.

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