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Surgical Removal of Impacted Lower Wisdom Tooth (#38) with Extraction of Molar (#37)

Surgical Procedure

Chief Complaint

Patient presented with severe pain and tenderness in the lower left posterior region despite analgesic intake earlier in the day.

Clinical Findings

  • Tooth #37

    • Very tender to percussion and palpation

    • Deep buccal and distal probing depths

    • Severe Class III furcation involvement

    • Gross buccal and distal bone loss

    • Combined periodontal–endodontic involvement

    • Poor prognosis / hopeless tooth

  • Tooth #38

    • Fully buried and impacted lower left wisdom tooth

CBCT revealed curved roots closely approximating the Inferior Dental Nerve (IDN)

Treatment Plan

  • Surgical removal of impacted tooth #38 under local anaesthesia

  • Extraction of hopeless tooth #37

  • Post-operative CBCT to confirm complete removal and nerve integrity

  • Patient counselling regarding risk of temporary paraesthesia

Pre-operative Assessment

  • Pre-operative photographs taken

  • CBCT imaging reviewed with the patient

  • High risk of temporary paraesthesia to the lower lip and tongue explained due to close proximity of roots to the IDN

  • Surgical complexity, risks, and expected outcomes discussed

  • Patient demonstrated understanding and was agreeable to proceed

  • Informed consent obtained

Anesthesia

  • Local anaesthesia administered:

    • Left Inferior Dental Nerve (IDN) block

    • Lingual Nerve (LN) block

Long Buccal Nerve (LBN) block

Surgical Procedure

Surgical Removal of Impacted Tooth #38

  • Patient cleaned and draped under sterile conditions

  • Buccal incision made and full-thickness flap raised

  • Bone guttering performed to access the impacted tooth

  • Tooth sectioned and removed in multiple fragments

  • Thorough curettage of the socket

  • Surgical site irrigated with sterile saline

  • Primary closure achieved with sutures

  • Hemostasis confirmed and post-operative instructions provided

Extraction of Tooth #37

  • Extraction performed under local anaesthesia

  • Socket irrigated with sterile saline

  • Hemostasis achieved

  • Post-operative instructions given

Post-operative Assessment

  • Post-operative CBCT taken

  • No retained tooth fragments detected

  • Inferior Dental Nerve confirmed intact and not involved in the surgical site

  • Patient reassured regarding the proximity of roots to the nerve

  • Advised that temporary paraesthesia, if present, may take up to several months to resolve

Patient acknowledged and understood the explanation

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