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  • Writer's pictureQuek And Me Dental Surgery

Completely bone-buried and impacted wisdom tooth removal

Wisdom teeth, or third molars, often pose significant challenges for dental professionals. This case study focuses on the removal of tooth #38, a completely bone-buried and impacted wisdom tooth. The patient presented with pain and swelling, leading to the decision for extraction.

bone-buried and impacted wisdom tooth x-ray
Completely bone-buried and impacted wisdom tooth

Pre-Operative Assessment

Before proceeding with the extraction, a comprehensive Cone Beam Computed Tomography (CBCT) scan was reviewed. This imaging provided detailed insight into the positioning and condition of the impacted tooth, crucial for planning the surgery.

Patient Consultation and Agreement

The patient was informed about the procedure and associated risks, including the potential for paresthesia (numbness) in the lower lip and tongue. Understanding the risks and benefits, the patient agreed to proceed with the surgery. The financial aspect was also discussed for the surgical removal as well as grafting.

Surgical Procedure

The surgery began with the administration of a local anesthetic (LA) block to the left inferior dental nerve (IDN), lingual nerve (LN), and long buccal nerve (LBN). Once the patient was adequately anesthetized, the following steps were performed:

  1. Cleaning and Draping: The patient was cleaned and draped to maintain a sterile environment.

  2. Incision and Buccal Flap: An incision was made, and a buccal flap was raised to access the tooth.

  3. Bone Guttering and Tooth Sectioning: Bone guttering was performed to expose the tooth, which was then sectioned into manageable pieces.

  4. Tooth Removal: Tooth #38 was elevated out in seven pieces.

  5. Curettage and Irrigation: The area was cleaned using curettage and irrigated with saline to ensure no debris remained.

surgically removed impacted wisdom tooth
Impacted Wisdom tooth removed

Grafting Procedure

After the extraction, the distal area of tooth #37 required grafting for Preservation of the Socket. The materials used were:

  • EthOss 1.0cc

  • Osteon II Collagen artificial bone grafting material (6mm x 10mm)

Post surgical site
Suture placed after wisdom tooth removal

Closure and Haemostasis

To achieve primary closure, four BSS were placed. Haemostasis was ensured, and post-operative instructions (POI) were provided to the patient.

Post-Operative Assessment

A follow-up CBCT scan was taken post-operation to confirm the complete removal of the tooth with no remnants left behind. Importantly, the inferior dental nerve was not involved during the surgery, minimizing the risk of lasting paresthesia.

Post wisdom tooth removal x-ray
Completely bone-buried and impacted wisdom tooth surgically removed & bone grafted

This case highlights the complexity and precision required in wisdom tooth extractions, especially when dealing with impacted teeth buried in bone. Through careful planning, patient communication, and skilled execution, successful outcomes can be achieved even in challenging scenarios. The patient was well-informed and agreeable throughout the process, contributing to the overall success of the treatment.

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