Surgical Removal of Impacted Tooth #38
Surgical Removal
Impacted Wisdom Tooth, Extraction
Chief Complaint
Patient presents with pain and swelling, requesting removal of tooth #38. Tooth #38 is impacted with long thin roots and bulbous apices, closely contacting the inferior dental nerve (IDN). Tooth #37 also shows signs of caries.
Clinical Findings
Tooth #38: Impacted with long thin roots and bulbous apices, very tender to percussion (TTP), carious to the pulp, and in close proximity to the IDN. Mobility within normal limits.
Tooth #37: Carious to the pulp, very tender to percussion (TTP), with mobility within normal limits.
Treatment Plan
Option 1: Local anesthesia (LA) and surgical removal of tooth #38, and X-ray examination (XAP) of tooth #37.
Option 2: Local anesthesia (LA) and surgical removal of tooth #38, followed by root canal therapy (RCT), post core (PC), and crown placement for tooth #37.
Pre-operative Assessment
Pre-operative CBCT reviewed.
Risks of paresthesia to the lower lip and tongue discussed.
Procedures explained in detail.
Patient opted for Option 1 and consented to the LA OP removal of tooth #38.
Anesthesia
Local anesthesia block administered to left inferior dental nerve (IDN), lingual nerve (LN), and long buccal nerve (LBN).
Surgical Procedure
1. Patient cleaned and draped.
2. Incision made, and buccal flap raised.
3. Bone guttering performed.
4. Tooth #38 sectioned and elevated in eleven pieces.
5. X-ray examination (XAP) of tooth #37 with bone guttering due to long roots and dense bone.
6. Curettage and irrigation with saline.
7. Bone grafting material (BSS x 07) applied for primary closure.
8. Haemostasis achieved, and post-operative instructions provided.
Post Operation Gallery
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Post-operative Assessment
Pre-operative CBCT reviewed.
Risks of paresthesia to the lower lip and tongue discussed.
Procedures explained in detail.
Patient opted for Option 1 and consented to the LA OP removal of tooth #38.