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Surgical Removal of Impacted #48 and #18

Surgical Removal

Chief Complaint

Pain and swelling associated with fully buried and impacted lower right third molar (#48).

Clinical Findings

Tooth #48:

  • Completely buried in bone

  • Impacted

  • Associated pain and swelling

Tooth #18:

  • Partially erupted

  • Impacted

  • Indicated for surgical removal

Pre-operative CBCT reviewed with patient, confirming positions and anatomical considerations.

Treatment Plan

  • Surgical removal of buried and impacted #48

  • Surgical removal of partially erupted and impacted #18

  • Irrigation, curettage, and primary closure with sutures

  • Post-operative CBCT to confirm clearance

Pre-operative Assessment

  • Risks discussed, including:
    • Inferior alveolar nerve paresthesia
    • Lingual nerve involvement
    • Oro-antral communication

  • Procedures explained in detail

  • Patient understood and agreed

Informed consent obtained

Anesthesia

  • Right IDN, LN, and LBN block for #48

  • LA infiltration for #18

Surgical Procedure

Tooth #48 – Buried & Impacted

  • Patient cleaned and draped

  • Incision made; buccal flap raised

  • Bone guttering performed

  • Tooth sectioned

  • #48 removed in 9 pieces

  • Curettage and saline irrigation

  • BSS × 4 placed for primary closure

  • Hemostasis achieved

Tooth #18 – Partially Erupted & Impacted

  • Incision and buccal flap raised

  • Bone guttering performed

  • Tooth sectioned

  • #18 removed in 2 pieces

  • Curettage and saline irrigation

  • BSS × 1 placed for primary closure

  • Hemostasis achieved

Post-operative instructions provided.

Post-operative Assessment

  • Post-op CBCT confirmed complete removal of both teeth

  • No remnants noted

  • Inferior alveolar nerve and maxillary sinus intact and uninvolved

  • Patient reassured and discharged in stable condition

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