Surgical Removal of a Deep Horizontally Impacted Lower Wisdom Tooth (#38) with Upper Wisdom Tooth Extraction (#28)

Surgical Removal

Chief Complaint

Patient presented with pain and swelling from #38; the opposing #28 was traumatically biting the operculum.

Clinical Findings

Tooth #38 was deeply and horizontally impacted.
Tooth #28 was contributing to traumatic occlusion over the operculum.
Pre-operative CBCT was reviewed to assess the relationship of #38 to the IDN.

Treatment Plan

Surgical removal of #38.
Extraction of #28.
Pre- and post-operative imaging.

Pre-operative Assessment

The risks of paraesthesia affecting the lower lip and tongue and oro-antral communication associated with upper wisdom tooth extraction were discussed. The patient understood and consented.

Anesthesia

Left Inferior Dental Nerve Block (IDN).
Lingual Nerve Block (LN).
Long Buccal Nerve Block (LBN).
Local anaesthesia at #28.

Surgical Procedure

A flap was elevated and bone guttering performed at #38.
#38 was sectioned and removed in nine pieces.
Three sutures were placed.
#28, with four curved roots, was extracted intact.
Post-operative CBCT confirmed complete removal with intact IDN and maxillary sinus.

Post-operative Assessment

Both surgical sites achieved haemostasis.
Complete removal was confirmed radiographically.
The IDN and maxillary sinus remained intact.