Patient Profile
- Chief Complaint: Patient reported cheek biting on the left side of the face for the past few days.
- Medical History: Not significant
- Clinical Examination Findings:
- Tooth 28: Buccally positioned third molar causing mucosal trauma
- Tooth 38: Buccally decayed, partially erupted with potential for food lodgment and future infection
4. Radiographic Evaluation: OPG advised to assess root morphology and relation to vital structures
Diagnosis
- 28: Erupting or malpositioned maxillary third molar leading to soft tissue trauma and cheek biting
- 38: Buccally decayed, partially impacted mandibular third molar
- Treatment Plan:
- Simple extraction of 28
- Surgical extraction of 38 due to impaction and deep caries involvement
Treatment Details
1. Extraction of Tooth 28
- Local anesthesia administered (posterior superior alveolar nerve block).
- Tooth 28 extracted using elevators and forceps.
- Hemostasis achieved with minimal trauma.
2. Surgical Extraction of Tooth 38
Step-by-Step Surgical Procedure
1. Anesthesia:
- Inferior alveolar nerve block with lingual and buccal nerve anesthesia.
2. Incision and Flap Reflection:
- A crestal incision with distal extension was made.
- Full-thickness mucoperiosteal flap reflected to expose the tooth and bone.
3. Bone Guttering:
- Buccal bone removed using a surgical bur under copious saline irrigation to gain access to the crown.
4. Tooth Sectioning:
- Tooth was sectioned into crown and root portions for easier removal.
5. Tooth Removal:
- Each segment elevated and extracted carefully without damaging adjacent structures.
6. Debridement & Irrigation:
- Thorough saline irrigation of the socket to remove debris and prevent infection.
7. Suturing:
- Site closed with 3-0 resorbable sutures.
- Postoperative instructions given.
Postoperative Care
- Antibiotics and analgesics prescribed.
- Cold compress for 24 hours post-surgery to reduce swelling.
- Soft diet for 3–5 days.
- Chlorhexidine mouthwash advised twice daily.
- Suture removal (if non-resorbable) scheduled after 7 days.
Follow-Up
- Healing checked at 1-week post-op visit.
- Patient reported relief from cheek biting and no further discomfort.
- Full healing expected over 2–3 weeks.
Outcome
- Removal of both upper and lower third molars successfully eliminated soft tissue trauma.
- Prevented future infection and discomfort from the decayed 38.
- Patient satisfied with the outcome and advised regular follow-ups.