A 26-year-old patient reported with a complaint of pain in the lower left back tooth for the last 7–10 days. The pain was intermittent, increasing on chewing, and caused significant discomfort.

The patient’s medical history was non-contributory.

On clinical examination, tenderness was noted in relation to the lower left third molar region. To confirm the findings, an Orthopantomogram (OPG) was advised, which revealed an impacted mandibular third molar (38).

Based on the diagnosis, an extraction of 38 under local anesthesia was planned and carried out.

Diagnosis

  • Chief Complaint: Pain in lower left back tooth for 7–10 days.
  • Clinical Findings: Tenderness in relation to 38, partially visible tooth.
  • Radiographic Findings (OPG): Impacted mandibular third molar (38).
  • Final Diagnosis: Symptomatic impacted mandibular left third molar (38).

Treatment Performed: Extraction of 38 Under Local Anesthesia

Step 1: Preparation & Anesthesia

  • Patient was prepared under aseptic conditions.
  • Local anesthesia was administered: Inferior alveolar nerve block, lingual nerve block, and long buccal nerve block using 2% Lignocaine with 1:80,000 adrenaline.
  • Adequate anesthesia was confirmed.

  • Step 2: Incision & Flap Reflection

  • A Ward’s incision was placed along the external oblique ridge with a small relieving incision.
  • A full-thickness mucoperiosteal flap was elevated to expose the surgical site.

Step 3: Bone Removal

  • Buccal bone overlying the tooth was carefully removed using a straight surgical bur with copious saline irrigation.
  • Adequate space was created for tooth delivery.

Step 4: Tooth Removal

  • The tooth was luxated using elevators and removed.
  • Root pieces were checked to confirm complete extraction.
  • Sharp bony margins were smoothened with a bone file.

Step 5: Closure

  • The socket was irrigated with sterile saline and checked for hemostasis.
  • The flap was repositioned and sutured with 3-0 black silk sutures

Postoperative Instructions

  • Cold compress over the surgical site for the first 24 hours.
  • Avoid spitting, rinsing, or using a straw for 24 hours.
  • Eat soft, non-spicy food and maintain hydration.
  • Medications prescribed: Antibiotics, analgesics, and antiseptic mouth rinse.
  • Follow-up scheduled after 7 days for suture removal.

Outcome

The patient tolerated the procedure well. Pain reduced significantly after extraction, and healing was uneventful on follow-up.

Discussion

Mandibular third molars are commonly impacted due to lack of space in the jaw. Impacted 38 can cause pain, food lodgment, gum swelling, and repeated infections if not treated on time. Surgical extraction remains the gold standard to eliminate pain and prevent future complications.

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