Surgical Removal of Impacted Cystic #38 with Bone Grafting + Extraction of Non-functional #28
Surgical Procedure
Chief Complaint
Patient reports pain and swelling over the lower left region; requests removal of tooth #38.
Clinical Findings
Tooth #38 completely buried in bone, impacted and distalised.
Associated odontogenic cyst ~13.5 mm in diameter surrounding #38.
Tooth #28 non-functional and indicated for extraction.
Pre-operative CBCT repeated FOC to assess for further tooth movement.
No signs of involvement of inferior dental nerve or maxillary sinus on imaging.
Treatment Plan
LA OP removal of impacted cystic #38 with cyst enucleation and bone grafting to prevent collapse and minimise post-op bone loss.
LA XAP extraction of non-functional #28.
Post-op CBCT to verify complete removal and nerve integrity.
Standard post-operative reviews.
Pre-operative Assessment
CBCT reviewed.
Risks explained: paraesthesia to lower lip/tongue, OAF/OAP, swelling, bleeding, post-op pain, infection.
Procedure steps explained thoroughly.
Quotation provided and patient agreeable.
Informed consent obtained for LAOP #38 and XAP #28.
Anesthesia
Left IAN block, LN block, LBN block for #38.
Local infiltration for #28.
Surgical Procedure
Tooth #38 – LAOP Removal
Patient cleaned, draped, prepared.
Incision made; buccal flap raised.
Buccal bone guttering performed.
Tooth sectioned and removed in 19 fragments due to deep impaction and cystic involvement.
Cavity curetted thoroughly; saline irrigation performed.
Large residual bony cavity noted.
Bone grafting performed using Dentium Osteon II Collagen (6 mm × 10 mm) cylinders × 3, packed to maintain ridge contour and reduce post-op bone loss.
BSS × 3 placed for primary closure.
Hemostasis achieved; POI given.
Tooth #28 – LA XAP Extraction
Simple extraction performed.
Socket irrigated with saline.
Hemostasis achieved; POI given.
Post-operative Imaging
Post-op CBCT taken.
No tooth remnants noted.
IDN intact; maxillary sinus not involved.
Post-operative Assessment
Wounds clean with good primary closure.
Hemostasis stable.
Bone graft comfortably seated.
Patient tolerated procedure well.
Standard post-operative care instructions given and understood.