Surgical Removal of an Impacted Lower Wisdom Tooth (#48) with Extraction of Teeth #47 and #18

Surgical Removal

Chief Complaint

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

Clinical Findings

Tooth #48 was mesially impacted with gross mesio-occlusal caries extending to the pulp and an associated periapical lesion.
Tooth #47 had extensive distal-occlusal caries with pulpal involvement, a buccal sinus and periapical pathology with a guarded prognosis.
Tooth #18 was non-functional with poor oral hygiene and traumatic contact.
Pre-operative CBCT was reviewed to assess the impacted tooth and surrounding structures.

Treatment Plan

Surgical removal of impacted #48.
Root canal treatment or extraction of #47 was discussed; the patient elected extraction.
Extraction of non-functional #18.
Post-operative imaging and routine review.

Pre-operative Assessment

The patient was informed of the surgical procedure, risk of altered sensation affecting the lower lip and tongue, and the risk of oro-antral communication associated with upper wisdom tooth extraction. The patient elected removal of all three teeth and provided informed consent.

Anesthesia

Right Inferior Dental Nerve Block (IDN).
Lingual Nerve Block (LN).
Long Buccal Nerve Block (LBN).
Local anaesthesia at #18.

Surgical Procedure

Tooth #47 was extracted.
#48 was surgically exposed with flap elevation and bone guttering, sectioned and removed in three sections.
The socket was curetted and irrigated and eight sutures were placed.
Tooth #18 was extracted under local anaesthesia.
Post-operative CBCT confirmed complete removal with the IDN and maxillary sinus intact.

Post-operative Assessment

Satisfactory haemostasis was achieved.
Complete removal was confirmed radiographically.
Post-operative care instructions were provided.