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Completely Bone-Buried and Impacted Wisdom Tooth Removal

Wisdom teeth, also known as third molars, frequently present complex challenges in dental care. This case study delves into the extraction process of a deeply impacted and fully encased wisdom tooth, designated as tooth #38. The patient experienced pain and swelling, necessitating the decision to remove the tooth.

Pre-Operative Assessment for Wisdom Tooth Extraction

Prior to initiating the extraction procedure, a detailed Cone Beam Computed Tomography (CBCT) scan was carefully reviewed. This advanced imaging provided crucial insights into the precise positioning and condition of the impacted tooth, essential for planning the surgical approach.

Patient Consultation and Informed Consent

During the consultation, the patient received comprehensive information regarding the procedure, including potential risks such as paresthesia (numbness) in the lower lip and tongue. After discussing the risks and benefits, the patient consented to undergo the surgery. The financial considerations for both the extraction and potential grafting procedures were also thoroughly addressed.

Surgical Procedure

The surgery commenced with the administration of a local anesthetic (LA) block to the left inferior dental nerve (IDN), lingual nerve (LN), and long buccal nerve (LBN). Once adequate anesthesia was achieved, the following steps were performed:

1. Cleaning and Draping

The patient underwent meticulous cleaning and draping procedures to maintain a sterile surgical environment.

Completely bone-buried and impacted wisdom tooth X-RAY

Completely bone-buried and impacted wisdom tooth

2. Incision and Buccal Flap

An incision was skillfully made, followed by the careful elevation of a buccal flap to gain access to the impacted tooth.​

3. Bone Guttering and Tooth Sectioning

To facilitate access and removal, precise bone guttering techniques were employed. Subsequently, the tooth was delicately sectioned into manageable pieces.​

4. Tooth Removal

The extraction of tooth #38 was completed in seven pieces, ensuring thorough removal while minimizing disruption.

5. Curettage and Irrigation

Post-extraction, the surgical site underwent thorough cleaning using curettage techniques and saline irrigation to eliminate any residual debris.

Impacted wisdom tooth removed

Grafting Procedure for Preservation of Socket

Following the extraction, grafting was necessary to preserve the socket in the distal area of tooth #37. The following materials were utilized:

  • EthOss 1.0cc

  • Osteon II Collagen artificial bone grafting material (6mm x 10mm)

This procedure helps maintain bone structure and supports optimal healing post-extraction.

Suture placed after wisdom tooth removal

Impacted Wisdom tooth removed

Closure and Hemostasis

To achieve primary closure, four BSS (absorbable sutures) were carefully placed. Hemostasis was meticulously ensured to control bleeding, and comprehensive post-operative instructions (POI) were provided to the patient.

Post-Operative Assessment

Following the procedure, a follow-up Cone Beam Computed Tomography (CBCT) scan was conducted to verify the complete extraction of the tooth, ensuring no remnants were left behind. Importantly, the surgical approach successfully avoided any involvement of the inferior dental nerve, reducing the risk of long-term paresthesia.

This case underscores the intricacy and exactitude demanded in extracting impacted wisdom teeth deeply embedded in bone. With meticulous planning, clear patient communication, and expert execution at Quek and Me Dental Surgery, successful outcomes can be attained even in complex scenarios. Throughout the process, the patient was well-informed and cooperative, which significantly contributed to the overall success of the treatment.

Suture placed after wisdom tooth removal

Surgical Removal and Bone Grafting of Completely  Bone-Buried and Impacted Wisdom Tooth X-RAY

Surgical Removal and Bone Grafting of Completely

Bone-Buried and Impacted Wisdom Tooth

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