Surgical Removal of Partially Erupted and Distally Impacted #38 and Extraction of #28
Surgical Removal
Chief Complaint
Patient complained of pain on #38, associated with traumatic biting of the buccal cheek tissue by #28.
Clinical Findings
#28 disto-buccally and supra-erupted, causing traumatic clipping of cheek tissue.
#38 partially erupted and distally impacted.
Limited mouth opening; strong tongue reflex; patient exhibited jerky movements due to dental phobia.
Mobility and probing depth within normal limits.
Treatment Plan
Extraction of #28 (XAP #28).
Surgical removal of #38 under local anesthesia (OP #38) due to dense bone, difficult positioning, and incomplete eruption.
Patient informed of risks including paresthesia, oroantral communication (OAP), and informed consent obtained.
Pre-operative Assessment
OPG and pre-operative CBCT reviewed.
#28 with long roots and dense surrounding bone.
#38 with curved roots close to #37 and inferior dental nerve (IDN).
No sinus involvement noted.
Anesthesia
Local anesthesia: IDN, lingual nerve, long buccal nerve blocks for #38.
Buccal and palatal infiltration for #28.
Surgical Procedure
Patient cleaned and draped.
#28 extracted under local anesthesia; hemostasis achieved; post-operative instructions given.
Buccal incision made for #38; flap raised.
Bone guttering performed; tooth sectioned.
#38 elevated in 12 pieces; curettage and irrigation with saline.
BSS × 05 placed for primary closure; hemostasis achieved.
Surgery noted as very difficult due to dense bone, patient movement, neck hyperextension, and backward tilting of #38.
Post-operative Assessment
Post-operative CBCT: no residual tooth fragments.
IDN intact; maxillary sinus not involved.
Patient reassured; stable condition on discharge.