Wisdom Tooth Operation for #18, #48
Surgical Removal
Chief Complaint
Patient complains of toothache in the fourth quadrant.
Clinical Findings
Tooth #48 mesially impacted with gross mesio-occlusal (MO) caries, very tender to percussion (TTP) and palpation (TTPp), mobility and periodontal depth within normal limits (WNL).
Tooth #47 possible distal caries (kiv), very slightly tender to percussion (STTP) and non-tender to palpation (NTTPp), mobility and periodontal depth WNL.
Tooth #18 buccally and distally tilted, non-functional, and poor oral hygiene.
Treatment Plan
Extraction (XAP) of tooth #18 and local anesthesia operation (LA OP) for removal of tooth #48.
Scaling and root planing (SRP) and follow-up (C/UP).
Crown (CAP) for tooth #47 (distal).
Pre-operative Assessment
Pre-operative CBCT taken and inferior dental nerve (IDN) traced.
Risks of parasthesia to lower lip and tongue, oral-antral perforation (OAP)/oral-antral fistula (OAF) explained.
Procedures and potential complications discussed.
Patient understood and agreed to the treatment plan, informed consent obtained.
Anesthesia
Local anesthesia (LA) block for right IDN, lingual nerve (LN), and long buccal nerve (LBN).
LA infiltration for tooth #18.
Surgical Procedure
Patient cleaned and draped.
Incision made and buccal flap raised on tooth #48.
Bone guttering performed.
Tooth sectioning and #48 elevated out in seven pieces.
Currettage and irrigation with saline.
Four bone substitute materials (BSS) placed for primary closure.
Hemostasis achieved and post-operative instructions (POI) provided.
LA extraction of tooth #18, elevated out in total.
Irrigation with saline and hemostasis achieved.
Post-operative Assessment
Post-operative CBCT taken.
IDN spared.
Maxillary sinus not complicated during extraction.
No tooth remnants noted in the socket.