Chief Complaint: Pain in the lower right back tooth region
History:
The patient presented with pain in the lower right posterior region. The dental history revealed that a filling was performed in relation to tooth 48 approximately 15 days ago. However, the patient reported persistent pain post-procedure, especially during mastication and while applying pressure on the tooth.
Clinical Examination:
- Tooth 48 was found to be partially erupted, with inflamed pericoronal tissue.
- On percussion, the tooth was tender (positive percussion test).
- Mild inflammation was noted, but no abscess or significant swelling was present.
- OPG (Orthopantomogram) was advised for further evaluation.
Radiographic Findings (OPG):
- Tooth 48 showed mesioangular impaction, with partial eruption.
- No significant proximity to the inferior alveolar nerve.
- Pericoronal radiolucency suggestive of localized infection or inflammation.
Diagnosis:
- Partially erupted and mesioangularly impacted tooth 48
- Pericoronitis with a history of recent restoration
- Chronic localized infection leading to recurrent pain
Treatment Plan:
- Surgical extraction of tooth 48 under local anesthesia
Surgical Procedure:
Preparation:
- Informed consent was obtained.
- Standard aseptic protocols were followed.
- Local anesthesia administered: Inferior alveolar nerve block, lingual nerve, and buccal nerve block using 2% lignocaine with 1:80,000 adrenaline.
Surgical Steps:
1. Incision and Flap Design:
- A Ward’s incision was made extending distal to the second molar.
- A full-thickness mucoperiosteal flap was reflected using a periosteal elevator to expose the surgical site.
2. Bone Guttering:
Buccal and distal bone surrounding the crown of 48 was removed using a surgical straight handpiece with a round carbide bur under continuous saline irrigation.
3. Tooth Sectioning:
- Due to the tooth’s angulation and partial bony impaction, sectioning of the crown was done vertically to facilitate removal.
- Each section was mobilized carefully using Coupland and Cryer elevators.
4. Tooth Removal:
- Both crown segments were extracted with minimal trauma.
- Complete removal confirmed by inspection and palpation of the socket.
5. Socket Debridement:
- The extraction socket was irrigated thoroughly with normal saline.
- Any granulation tissue or bony debris was curetted gently.
6. Hemostasis and Closure:
- Bleeding was controlled.
- The flap was repositioned and sutured using 3-0 black silk sutures with interrupted technique.
Postoperative Care:
Medications Prescribed:
- Antibiotic: Amoxicillin 500 mg TID for 5 days (or as appropriate based on patient profile)
- Analgesic: Ibuprofen + Paracetamol BID for 3 days
- Antiseptic mouthwash: Chlorhexidine 0.12% twice daily
Post-Operative Instructions:
- Avoid hot/spicy food for 24–48 hours
- No vigorous rinsing or spitting for the first 24 hours
- Apply cold compress for the first 6 hours (15 minutes on, 15 minutes off)
- Maintain oral hygiene with soft brushing
- Avoid smoking and alcohol
- Follow-up after 7 days for suture removal