Surgical Removal of Interlocked Impacted Wisdom Tooth #38 and Grossly Decayed Tooth #37
Surgical Removal
Chief Complaint
Patient complained of severe food trapping and pain in the lower left posterior teeth.
Clinical Findings
Clinical examination revealed a mesially impacted wisdom tooth (#38) lodged into the distal carious cavity of tooth #37.
Tooth #37 showed severe distal caries and significant distal bone loss of approximately 80%. Tooth #38 was vertically impacted with mesial tilting and had supra-erupted into the distal cavity of #37, resulting in both teeth becoming interlocked.
This created severe food impaction and localized periodontal destruction.
Pre-operative CBCT was reviewed for surgical planning and assessment of the relationship to the inferior dental nerve.
Treatment Plan
Surgical removal of impacted wisdom tooth #38.
Extraction of severely compromised tooth #37.
Post-operative CBCT verification.
Future treatment considerations:
Surgical removal of impacted teeth #18 and #48
Crown restoration for tooth #47 distal
Routine recall and monitoring
Pre-operative Assessment
CBCT imaging was reviewed to assess tooth position, bone loss, and proximity to the inferior dental nerve.
Risks including possible paraesthesia affecting the lower lip and tongue were explained.
Procedures were explained in detail and the patient agreed to proceed.
Informed consent obtained.
Anesthesia
Local anesthesia administered via left inferior dental nerve block, lingual nerve block, and long buccal nerve block.
Surgical Procedure
Patient was cleaned and draped under sterile conditions.
A surgical incision was made and a buccal flap was raised to expose the impacted teeth. Bone guttering was performed to gain access to the interlocked teeth.
Tooth sectioning was carried out to separate the teeth and facilitate removal.
Tooth #37 was elevated and removed in two fragments.
Tooth #38 was then elevated and removed in two fragments.
The surgical site was curetted and irrigated thoroughly with saline. Sutures were placed for primary closure and haemostasis was achieved.
Post-operative CBCT imaging confirmed complete removal with no remaining tooth fragments.
Post-operative Assessment
Post-operative CBCT confirmed no residual tooth fragments. The inferior dental nerve was not involved in the surgery.
Patient was reassured after the procedure.
Medication and post-operative care instructions were provided. Medical leave was issued.
Future follow-up and additional treatments were discussed.