Surgical Removal of Impacted Wisdom Tooth #48 and Extraction of Tooth #18
Surgical Removal
Chief Complaint
Patient presented with pain and swelling in the lower right posterior jaw region.
Clinical Findings
Clinical and radiographic assessment showed tooth #48 to be completely buried in bone and soft tissue, indicating a fully impacted wisdom tooth. The tooth was distalized and associated with a suspected cystic lesion.
CBCT imaging revealed that tooth #48 was in close contact with the inferior dental nerve. Tooth #18 was also noted to be very close to the maxillary sinus.
Treatment Plan
Surgical removal of impacted tooth #48 under local anesthesia.
Extraction of tooth #18 under local anesthesia.
Pre-operative and post-operative CBCT imaging to assess anatomical structures and confirm complete removal.
Pre-operative Assessment
Pre-operative CBCT was reviewed to evaluate the position of the impacted tooth and its proximity to the inferior dental nerve and maxillary sinus.
Risks including paraesthesia affecting the lower lip and tongue, as well as possible oroantral perforation or fistula, were explained to the patient.
Procedures were explained in detail.
Patient understood the risks and agreed to proceed.
Informed consent obtained.
Anesthesia
Local anesthesia administered via right inferior dental nerve block, lingual nerve block, and long buccal nerve block.
Surgical Procedure
Tooth #48:
Patient was cleaned and draped under sterile conditions.
A surgical incision was made and a buccal flap was raised to expose the impacted tooth. Bone guttering was performed to access the tooth. Tooth sectioning was carried out to facilitate removal, and the tooth was elevated and removed in multiple fragments.
The socket was curetted and irrigated thoroughly with saline. Sutures were placed for primary closure and haemostasis achieved.
Tooth #18:
Extraction was performed under local anesthesia. The socket was irrigated with saline and haemostasis achieved.
Post-operative CBCT confirmed complete removal with no remaining tooth fragments.
Post-operative Assessment
Post-operative CBCT confirmed that no tooth remnants remained. The inferior dental nerve and maxillary sinus were intact and were not involved in the surgery.
Patient was reassured after the procedure.