Surgical Removal of Impacted #38 and Extraction of #28

Surgical Removal

Impacted Wisdom Tooth

Chief Complaint

Patient complains of pain and swelling on the lower left side. Requested removal of tooth #38.

Clinical Findings

Tooth #38 impacted and completely buried in gingiva, almost fully encased in bone.

Pre-operative CBCT revealed the position and depth of impaction.

No signs of infection or sinus involvement pre-operatively

Treatment Plan

Local anesthetic (LA) surgical removal of impacted tooth #38.

LA extraction of tooth #28.

Informed consent obtained after discussing potential complications, including paraesthesia of the lower lip and tongue, and oro-antral communication (OAP/OAF).

Pre-operative Assessment

Medical and dental history reviewed.

Pre-operative CBCT taken to assess tooth position and proximity to vital structures.

Risks and benefits explained to the patient; patient understood and agreed to proceed.

Anesthesia

Left inferior dental nerve (IDN), lingual nerve (LN), and long buccal nerve (LBN) block administered for #38.

Local infiltration administered for #28.

Surgical Procedure

Patient cleaned and draped under aseptic conditions.
Buccal incision made and flap raised.
Bone guttering performed to expose tooth #38.
Tooth sectioned and elevated out in nine (9) pieces.
Socket curetted and irrigated thoroughly with saline.
Primary closure achieved with 4/0 black silk sutures × 4.
Hemostasis achieved; post-operative instructions given.
LA extraction of tooth #28 performed.
Socket irrigated with saline, hemostasis achieved.
Post-operative CBCT taken to confirm complete removal and check anatomical integrity.