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Management of Post-Operative Complications Following Wisdom Tooth Extraction

Oral Surgery
Post-Operative Complication Management
Management of Post-Operative Complications Following Wisdom Tooth Extraction

Chief Complaint

Patient reported severe pain at the site of previous wisdom tooth surgery on tooth #38.

Clinical Findings

  • Surgery on tooth #38 was performed on 2nd Dec 20XX by a previous operator.

  • Patient complained of dislodged/loose sutures and a loose flap post-operation, but the previous operator reassured that the sutures were secure and the flap was anchored.

  • Patient experienced pain a few days after surgery and was diagnosed with dry socket on 7th Dec 20xx by the previous operator. Wound was irrigated, medicament placed, and sutures applied.

  • Patient continued to experience severe pain and sought a second opinion.

  • Intraoral examination: Very loose flap with 2 sutures, flap not anchored, pus exudate in socket, small loose piece of dry socket medicament soaked with pus, food trapped under flap and in socket, infected and pus-covered bare bone in socket.

Treatment Plan

  1. Minor surgical procedure to expose socket and perform open flap debridement.

  2. Socket medicament packing and placement.

  3. Primary wound closure with suturing.

  4. Post-operative CBCT.

  5. Antibiotics (A/B).

Pre-operative Assessment

  • Pre-operative CBCT taken: IDN very close to socket, no evidence of bone guttering, IDN not affected during surgery, no remnant tooth structure in socket.

  • Tooth #28 (mesial) caries, non-functional.

  • Patient agreeable to the proposed treatment plan.

Anesthesia

Local anesthesia block administered: Left Inferior Dental Nerve (IDN), Lingual Nerve (LN), and Long Buccal Nerve (LBN).

Surgical Procedure

  1. Old sutures removed.

  2. Flap elevated.

  3. Socket debridement performed.

  4. Flap debridement done on flap, beneath flap, and surrounding bone.

  5. Saline irrigation performed.

  6. Bleeding stimulated.

  7. Aveogel packing placed into sockets.

  8. BSS x 06 placed for primary closure.

  9. Achieved haemostasis and provided post-operative instructions (POI).

Post Operation Gallary

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Post-operative Assessment

  • Pre-operative CBCT taken: IDN very close to socket, no evidence of bone guttering, IDN not affected during surgery, no remnant tooth structure in socket.

  • Tooth #28 (mesial) caries, non-functional.

  • Patient agreeable to the proposed treatment plan.

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