Surgical Removal of a Deep Buried Horizontally Impacted Lower Wisdom Tooth with Bone Grafting (#38)

Surgical Removal

Chief Complaint

Patient reported discomfort and pain when brushing around the lower left wisdom tooth (#38).

Clinical Findings

Tooth #38 was deeply and horizontally impacted and completely buried in bone.
Pre-operative CBCT was reviewed to assess its relationship to the Inferior Dental Nerve.
Bone grafting distal to #37 was planned following removal.

Treatment Plan

CBCT-guided surgical removal of #38.
Bone grafting of the surgical defect distal to #37.
Post-operative CBCT to confirm complete removal and assess surrounding structures.

Pre-operative Assessment

The patient was informed of the surgical procedure, the risk of temporary or permanent altered sensation, the rationale for bone grafting, and possible complications. Informed consent was obtained.

Anesthesia

Left Inferior Dental Nerve Block (IDN).
Lingual Nerve Block (LN).
Long Buccal Nerve Block (LBN).

Surgical Procedure

A buccal flap was elevated and bone guttering performed.
#38 was sectioned and removed in six pieces.
Bone graft material was placed and four sutures used for closure.
Post-operative CBCT identified a small retained lingual fragment, so the site was immediately re-entered and the fragment removed.
The graft was repositioned and the site closed with five sutures.
Repeat CBCT confirmed complete removal and an uninvolved IDN.

Post-operative Assessment

Complete removal was confirmed on repeat CBCT.
The graft was satisfactorily adapted.
The Inferior Dental Nerve remained intact.