Surgical Removal of a Grossly Carious Mesially Impacted Lower Wisdom Tooth (#38) with Upper Wisdom Tooth Extraction (#28)

Surgical Removal

Chief Complaint

Patient presented with pain and swelling from #38 and requested removal of the upper and lower left wisdom teeth.

Clinical Findings

Tooth #38 was grossly carious and mesially impacted.
Tooth #28 was indicated for extraction.
Pre-operative CBCT was reviewed to assess surrounding anatomy.

Treatment Plan

Surgical removal of #38.
Extraction of #28.
Pre- and post-operative CBCT imaging.
Routine post-operative care and review.

Pre-operative Assessment

The risks of altered sensation to the lower lip and tongue and oro-antral communication associated with upper wisdom tooth extraction were discussed. The patient understood and provided informed consent.

Anesthesia

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

Surgical Procedure

A buccal flap was elevated and bone guttering performed at #38.
#38 was sectioned and removed in ten pieces.
Four sutures were placed for closure.
#28 was extracted under local anaesthesia.
Post-operative CBCT confirmed no retained fragments and intact IDN and maxillary sinus.

Post-operative Assessment

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