Surgical Removal of Interlocked Impacted Molars with Advanced Caries – Teeth #37 and #38
Surgical Procedure
Chief Complaint
Patient complained of pain and severe food trapping in the lower left posterior region.
Clinical Findings
Medical consideration:
Patient allergic to Naproxen (Synflex); avoid NSAIDs
Tooth #38:
Mesially impacted
Supra-erupted into distal root caries cavity of tooth #37
Tooth #37:
Distal root caries extending to the pulp
Vertically impacted
Structurally unsound and unsuitable for predictable restoration
Severe distal bone loss (approximately 80%)
Teeth #37 and #38:
Impacted and interlocked
Resulting in severe food trapping and progressive periodontal breakdown
Pre-operative CBCT confirmed impaction pattern, interlocking relationship, extent of caries, and bone loss
Treatment Plan
Surgical removal of impacted wisdom tooth #38 under local anesthesia
Surgical removal of tooth #37 due to extensive caries and advanced bone loss
Post-operative imaging to confirm complete removal
Pre-operative Assessment
Pre-operative CBCT reviewed with patient
Risks, benefits, and procedural steps explained
Specific risks of paraesthesia involving the lower lip and tongue discussed
Medication allergy noted and considered in post-operative planning
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 three pieces
Tooth #38 elevated and removed in four pieces
Thorough curettage performed
Surgical site irrigated with saline
Eight 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