Surgical Removal of Impacted #48 with Adjacent Extractions (#18, #17, #47)
Surgical Removal
Chief Complaint
Pain and swelling associated with the lower right posterior region.
Clinical Findings
Tooth #48:
Fully buried and completely impacted in bone
Associated pain and swelling
CBCT showed close proximity to right IDN
Tooth #18:
Partially erupted and impacted
Tooth #17 & #47:
Crossbite
Guarded periodontal prognosis
Treatment Plan
LA oral surgery for removal of impacted #48
LA extraction (XAP) of #18, #17, and #47
Curettage, irrigation, and primary closure
Post-operative CBCT to confirm complete removal and nerve integrity
Pre-operative Assessment
CBCT reviewed with patient; IDN position plotted
Risks explained: lower lip/tongue paresthesia, OAP/OAF
Procedure and steps described
Patient understood and agreed
Informed consent obtained for LA OP removal of #48 and XAP of #18, #17 & #47
Anesthesia
Right IDN, LN, and LBN block
Local infiltration for #18, #17, #47
Surgical Procedure
Tooth #48 – Buried & Impacted
Patient cleaned and draped
Incision made; buccal flap raised
Bone guttering performed
Tooth sectioned
#48 removed in 2 pieces
Curettage and saline irrigation
BSS × 5 placed for primary closure
Hemostasis achieved
Extractions – #18, #17, #47
LA XAP for all three teeth
Site irrigation with saline
BSS × 4 placed for primary closure
Hemostasis achieved
Post-operative instructions given.
Post-operative Assessment
Post-op CBCT confirmed complete clearance of all roots
IDN and maxillary sinus intact and uninvolved
Patient reassured