Surgical Removal of Interlocked Impacted Molars – Teeth #37 and #38
Surgical Procedure
Chief Complaint
Patient complained of severe pain and persistent food trapping at the lower left posterior region.
Clinical Findings
Tooth #38:
Mesially impacted
Supra-erupted into the distal caries cavity of tooth #37
Tooth #37:
Distal caries present
Vertically impacted
Severe distal bone loss (approximately 80%)
Teeth #37 and #38 were impacted and interlocked, resulting in:
Severe food trapping
Progressive periodontal breakdown
Pre-operative CBCT confirmed the interlocking impaction pattern and extent of bone loss
Treatment Plan
Surgical removal of impacted wisdom tooth #38 under local anesthesia
Extraction of tooth #37 due to extensive distal caries and advanced bone loss
Post-operative imaging to confirm complete removal
Pre-operative Assessment
Pre-operative CBCT reviewed
Risks, benefits, and procedural steps explained
Specific risks of paraesthesia to the lower lip and tongue discussed
Patient understood and agreed to proceed
Informed consent obtained
Anesthesia
Local anesthesia via left inferior dental nerve (IDN), lingual nerve (LN), and long buccal nerve (LBN) block
Surgical Procedure
Patient cleaned and draped
Buccal incision made and flap raised
Bone guttering performed
Tooth sectioning carried out
Tooth #37 elevated and removed in two pieces
Tooth #38 elevated and removed in two pieces
Thorough curettage performed
Surgical site irrigated with saline
Five bone substitute sponges placed for primary closure
Hemostasis achieved
Post-operative instructions provided
Post-operative Assessment
Post-operative CBCT taken
No residual tooth fragments noted
Inferior dental nerve not involved
Patient reassured