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Wisdom Tooth Operation for Quadrant 4

Surgical Removal
Retained Root
Wisdom Tooth Operation for Quadrant 4

Chief Complaint

Patient complains of pain in the fourth quadrant.

Clinical Findings

  • Tooth #18: Traumatic bite on tooth #48 operculum.

  • Tooth #48: Partially erupted with pericoronitis and pus exudate, not impacted.

Treatment Plan

  • OPG (Orthopantomogram) taken.

  • Advised extraction (XAP) of teeth #18 and #48:

    • Possible operative procedure (OP) if complications arise during XAP:

  • Patient understood and agreed to proceed.

Pre-operative Assessment

Anesthesia

Local anesthesia (LA) for extraction of teeth #18 and #48.

Surgical Procedure

  1. Initial Extractions:

  • LA XAP for teeth #18 and #48.

  • Tooth #18: Distobuccal (db) root fractured and retained.

  • Tooth #48: Coronal portion completely fractured, retained roots.

2. Operative Removal of Retained Roots (LAOP):

  • Patient agreed to proceed with LAOP for removal of retained roots of teeth #18 and #48.

  • Pre-operative CBCT taken.

  • Risks of paresthesia to lower lip and tongue, and potential for oroantral perforation/fistula (OAP/OAF) explained.

  • Procedures, costs, and potential complications discussed.

  • Patient understood and agreed to proceed.

  • Informed consent obtained.

3. Operative Procedure:

  • Increased local anesthesia administered.

  • Patient cleaned and draped.

  • Incision made, buccal flap raised on teeth #18 and #48.

  • Bone guttering performed.

  • Tooth sectioning carried out.

  • Tooth #18 elevated out in two pieces.

  • Tooth #48 elevated out in three pieces.

  • Curettage performed, irrigated with saline.

  • Bioactive synthetic scaffold (BSS) placed x3 for primary closure of the #18 site.

  • BSS placed x3 for primary closure of the #48 site.

  • Hemostasis achieved, post-operative instructions given.

Post Operation Gallary

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Post-operative Assessment

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