Surgical Removal of Impacted #48, #47 with Severe Distal Caries and Periodontal Involvement
Surgical Removal
Chief Complaint
Persistent burning sensation on the right side of the face and ongoing discomfort despite multiple medical consultations and dental cleaning done previously.
Clinical Findings
Px experienced right-sided facial burning after taking fish oil; symptoms recurred despite anti-allergic medication.
Medical doctor suspected possible stroke (KIV) but no conclusive diagnosis; advised A&E if symptoms worsen.
Another doctor suspected sinusitis/infection and prescribed antibiotics.
SAP performed at another clinic for suspected food trap at impacted #48 — symptoms persisted.
Intra-Oral Examination:
#18 missing.
#48 mesially impacted, calculus present.
#47 distal deep caries, very sensitive to cold.
TTP, NTTPp; mobility WNL.
Deep probing depths on distal and lingual.
Severe food trap between #47 & #48.
CBCT Findings:
#48 mesially tilted, impacted and lodged into the distal carious cavity of #47.
#47 caries to pulp; severe distal bone loss (~70%).
#48 fused apex in very close proximity to / touching IDN.
#36 mobility with caries close to pulp; KIV pulpal involvement.
#37 distal bone loss; guarded perio prognosis.
Generalised moderate bone loss on posterior dentition.
Treatment Plan
LA OP surgical extraction of #47 and #48.
Discussed that removal will improve chewing discomfort and cold sensitivity.
Burning facial sensation unlikely to resolve with dental treatment; advised continuity of care with medical doctor/OMS surgeon.
Risks, benefits, procedures, and postoperative expectations explained.
Pre-operative Assessment
Reviewed CBCT with patient.
Discussed severe caries, interlocking impaction, bone loss, and proximity to IDN.
KIV better long-term prognosis with implant replacement over RCT + PC + crown for #47.
Anesthesia
LA block: Right IDN, LN, LBN.
Surgical Procedure
Px cleaned and draped.
Incision made; buccal flap raised.
Bone guttering performed.
Sectioning of #47 and #48.
Teeth elevated and removed in pieces.
Curettage and saline irrigation.
4/0 BSS × 8 sutures placed for primary closure.
Hemostasis achieved.
Post-operative CBCT taken.
Post-operative Assessment
Stable post-op condition.
Symptoms related to chewing discomfort and cold sensitivity expected to improve.
Burning facial sensation requires medical review; advised to return to doctor or OMS as previously discussed.