Surgical Removal of a Horizontally Impacted Lower Wisdom Tooth (#48) with Extraction of a Hopeless Adjacent Molar (#47)

Surgical Removal

Chief Complaint

Patient presented with pain and swelling associated with the lower right wisdom tooth (#48).

Clinical Findings

Tooth #48 was horizontally impacted.
Tooth #47 had a combined periodontal-endodontic lesion, a large periapical lesion and was considered non-restorable.
Pre-operative CBCT was reviewed to assess the relationship to the Inferior Dental Nerve.

Treatment Plan

Extraction of hopeless #47.
Surgical removal of impacted #48.
Thorough debridement and post-operative CBCT.

Pre-operative Assessment

The surgical approach and risk of altered sensation involving the lower lip and tongue were discussed. The patient understood the treatment plan and provided informed consent.

Anesthesia

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

Surgical Procedure

Tooth #47 was extracted.
Initial elevation of #48 was unsuccessful, so a buccal flap was raised and bone guttering performed.
#48 was sectioned and removed in three pieces.
The socket was curetted and irrigated and four sutures placed.
Post-operative CBCT confirmed complete removal with an intact IDN.

Post-operative Assessment

Complete removal was confirmed radiographically.
Satisfactory haemostasis was achieved.
The Inferior Dental Nerve remained intact.