Surgical Removal Wisdom Teeth #18 and #48

Chief Complaint

Patient requires extraction of wisdom teeth #18 and #48.

Pre-operative CBCT taken to evaluate the relationship of #18 and #48 with the right maxillary sinus and right inferior dental nerve (IDN).

Discussed the risks and procedures for the extraction (XAP) of #18 and #48.
Explained the potential need for surgical removal of retained roots of #18 and #48.
Patient understood and agreed to proceed with XAP #18 and #48 with the possibility of operative procedures if necessary.

Pre-operative CBCT taken.

Local anesthesia (LA) administered for the extraction of #18 and #48.

LA XAP of #18 and #48 performed using elevators and periotomes.
Teeth #18 and #48 elevated and extracted successfully using forceps.
During the extraction, sharp-edged root tips of #48 were noted, and after saline irrigation, no retained roots were visible.
Post-operative CBCT revealed a retained root tip of #48 (3.5mm x 2.0mm).
Patient requested removal of the retained root.
Advised LA operative removal of the retained root of #48.
Patient agreed and informed consent was taken.
Explained the difficulty in accessing the retained root to the patient.
Patient was cleaned and draped.
Incision made, buccal flap raised, and bone guttering performed.
Initially, the retained root could not be accessed.
Two additional CBCT scans taken with gutta-percha sections to trace the retained root.
After much effort and struggle, the retained root of #48 was elevated out.

Pre-operative CBCT taken.