Wisdom Tooth Removal of #47, #48
Surgical Removal
Extraction, Impacted Wisdom Tooth
Chief Complaint
Patient complains of pain in the 4th quadrant.
Clinical Findings
Tooth #47: very deep caries, possibly extending to the pulp, very tender to percussion (TTP) and palpation (TTPp), mobility, and very deep probing depth on distal.
Periapical (PA) radiograph taken, showing impacted tooth #48 with deep horizontal impaction.
Bone loss to apices of tooth #47 due to impaction of #48.
Cone Beam Computed Tomography (CBCT) taken, showing horizontal impaction of #48, inferior dental nerve (IDN) touching lingual side of #48 roots, IDN plotted.
Treatment Plan
Local Anesthesia (LA) exploratory periapical surgery (XAP) of tooth #47 due to sub-crestal caries on buccal and pulpitis; guarded restorative prognosis.
LA oral procedure (OP) removal of impacted tooth #48.
Pre-operative Assessment
Risks and procedures for XAP of #47 and LAOP of #48 explained.
Patient agreeable to proceed with treatment today.
Informed consent for LAOP removal of impacted #48 and LA XAP of #47 obtained.
Anesthesia
LA block (right) inferior dental nerve (IDN), lingual nerve (LN), and long buccal nerve (LBN).
Surgical Procedure
Patient cleaned and draped.
Incision made, buccal flap raised.
Bone guttering performed.
Tooth #47 sectioned and elevated out in broken pieces due to caries.
Tooth #48 sectioned and elevated out in 3 pieces.
Currettage performed, irrigation with saline.
BSS (biodegradable sutures) x 07 placed for primary closure.
Hemostasis achieved, post-operative instructions (POI) given.
Post Operation Gallery
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Post-operative Assessment
Risks and procedures for XAP of #47 and LAOP of #48 explained.
Patient agreeable to proceed with treatment today.
Informed consent for LAOP removal of impacted #48 and LA XAP of #47 obtained.