Surgical Removal of Mesially Impacted #48 with Pericoronitis and Extraction of #18
Surgical Removal
Chief Complaint
Patient complains of severe pain and swelling on the lower right side.
Requested removal of tooth #48.
Clinical Findings
Tooth #48:
Partially erupted
Mesially impacted
Active pericoronitis
Significant swelling and tenderness
Poor oral hygiene; plaque ++++
Tooth #18:
Biting into the operculum overlying #48
Contact with bony ridge distal to #48
Contributing to chronic irritation
Radiographic Findings (Pre-op CBCT):
#48 mesial impaction confirmed
Crown partially visible; roots not encroaching IDN
Adjacent structures intact
Treatment Plan
LA OP surgical removal of #48
LA XAP of #18
Risks explained including:
Paraesthesia to lower lip/tongue
Oro-antral penetration / fistula
Post-op swelling and infection risk
Patient understood and agreed to proceed
Informed consent obtained
Pre-operative Assessment
Pre-op CBCT reviewed with patient
No radiographic contraindications
Medical history non-contributory
Indications for urgent removal due to pericoronitis and swelling
Anesthesia
LA block: Left IDN, LN & LBN
Additional LA infiltration at #18
Surgical Procedure
Patient cleaned and draped.
Incision made; buccal flap raised.
Bone guttering performed to access #48.
Tooth sectioned.
#48 elevated and removed in three pieces.
Socket curettaged; saline irrigation performed.
Closure with BSS × 05 for primary closure.
Hemostasis achieved; POI given.
#18 Extraction:
LA XAP #18 performed
Saline irrigation
Hemostasis achieved; POI given
Post-operative Assessment
Post-op CBCT taken
No retained tooth fragments
IDN intact and not involved
Maxillary sinus uninvolved
Flap closure stable
Patient reassured; post-op care instructions reinforced