Surgical Removal of mesial Impacted Tooth #48
Surgical Procedure
Chief Complaint
Patient reports persistent pain on the lower right side for 3 days.
Clinical Findings
Tooth #48 shows partial eruption with mesial impaction.
Deep caries present on mesio-occlusal surface.
Patient previously experienced similar pain episodes in 10months ago and years prior.
Took 1 tramadol tablet 2 days ago.
Irregular dental visits; attends only when in pain.
LDV performed several years ago.
Patient requests extraction of tooth #48.
Pre-operative CBCT taken and reviewed.
Treatment Plan
LA surgical removal of tooth #48.
LA extraction of tooth #18 was advised but patient declined.
Patient agreed to proceed with removal of #48 only.
Patient opted to use parents’ Medisave for the procedure.
Risks of lower lip and tongue paraesthesia explained; all procedures and postoperative expectations discussed.
Pre-operative Assessment
Vital signs stable.
CBCT confirms mesial impaction and extent of caries.
No contraindications to local anesthesia.
Anesthesia
3 carpules of 2% Scandonest administered via:
Right inferior dental nerve block
Lingual nerve block
Long buccal nerve block
Surgical Procedure
Patient cleaned and draped under aseptic protocol.
Incision made and buccal flap raised.
Minimal buccal bone guttering performed.
Tooth sectioned appropriately.
Tooth #48 elevated and delivered in two pieces.
Curettage of socket and saline irrigation performed.
BSS x3 placed to support primary closure.
Hemostasis achieved.
Post-operative instructions given.
Post-operative Assessment
No immediate complications.
Patient stable and reassured.
Advised on postoperative care, medications, and red-flag symptoms.