Patient Profile
Medical History: No relevant medical history
Chief Complaint: Patient complained of cheek bite and painful ulceration on the right inner cheek for the past 7–10 days.
Clinical Examination
On intraoral examination:
- A grossly decayed and buccally placed 18 (upper right third molar) was found to be impinging on the right buccal mucosa.
- Ulceration and inflammation noted on the corresponding cheek area, consistent with repeated trauma from 18.
- On the lower right side, tooth 48 was noted to be partially erupted, with pericoronal inflammation and soft tissue entrapment suggestive of chronic pericoronitis.
- No signs of systemic illness.
Radiographic Evaluation
- Orthopantomogram (OPG) advised and taken
Diagnosis
- Traumatic ulcer on right buccal mucosa due to buccally placed, decayed 18
- Chronic pericoronitis and soft tissue impaction associated with 48
Treatment Plan
- Extraction of tooth 18 (simple extraction)
- Surgical extraction of tooth 48 (partially impacted)
Procedure Details
Pre-operative Measures:
- Thorough clinical and radiographic planning
- Written informed consent obtained
- Area disinfected with chlorhexidine rinse
- Local anesthesia: 2% lignocaine with 1:100,000 adrenaline
Extraction of 18 (Upper Right Third Molar)
- Tooth was grossly decayed and buccally placed, with minimal bony support
- Elevator used to luxate the tooth gently
- Tooth extracted with minimal trauma
- Hemostasis achieved with gauze pressure
Surgical Extraction of 48 (Lower Right Third Molar)
Step-by-Step Surgical Procedure:
1. Local Anesthesia:
- Inferior alveolar nerve block + long buccal nerve block administered
2. Flap Design:
- Triangular mucoperiosteal flap raised using a no. 15 blade to expose the tooth and bone
3. Bone Removal:
- Buccal bone guttering done with surgical handpiece and bur, under continuous saline irrigation
4. Tooth Sectioning:
- Crown and root separated for easier removal due to partial impaction
5. Tooth Removal:
Each section removed carefully using elevators
6. Debridement and Irrigation:
- Socket curetted to remove debris and infected tissue
- Irrigated thoroughly with saline and povidone iodine
7. Closure:
- Flap repositioned and sutured with 3-0 silk sutures
- Post-operative gauze pack placed
Post-operative Instructions
1. Advised cold compress in first 24 hrs
2. Soft diet and proper oral hygiene
3. Avoid hot/spicy food and refrain from touching the ulcer area
4. Prescribed medications:
- Antibiotics
- NSAIDs
- Antiseptic mouthwash (chlorhexidine)
6. Follow-up scheduled in 7–10 days for suture removal and review
Outcome
- Immediate relief from traumatic source of cheek ulcer
- Healing ulcer observed in follow-up
- No post-operative complications
- Patient advised for long-term oral hygiene and regular dental check-ups