Chief Complaint: Food lodgment in the upper and lower left back tooth region for the past 1–2 months.
Clinical Examination:
The patient reported persistent food impaction that caused discomfort while chewing and occasional bad breath. Clinical inspection revealed:
- Tooth 28 (Upper Left Third Molar): Grossly decayed and tender on percussion.
- Tooth 38 (Lower Left Third Molar): Deep caries, partially erupted, and showing signs of pericoronitis. The patient experienced pain during mouth opening and occasional swelling.
Vitality Testing: Both teeth were tender on percussion (TOP positive), indicating pulpal and possibly periapical involvement.
Radiographic Assessment:
An OPG (Orthopantomogram) was advised to assess the position, angulation, and relation to vital structures like the maxillary sinus (28) and the inferior alveolar nerve (38).
Findings:
- 28: Horizontally placed with close proximity to the maxillary sinus.
- 38: Mesioangular impaction with partial eruption and close proximity to the inferior alveolar canal.
Treatment Plan:
Based on the clinical and radiographic findings, the following treatment was advised and carried out:
- Extraction of 28 under local anaesthesia.
- Surgical extraction of 38 teeth under local anaesthesia due to their impaction and angulation.
Treatment Procedure:
Step 1: Local Anaesthesia
The surgical area was anaesthetised using 2% lignocaine with adrenaline. Adequate numbness was ensured before proceeding.
Extraction of 28:
A relatively straightforward extraction was performed:
- A periosteal elevator was used to reflect the tissue.
- A straight elevator followed by forceps was used to luxate and extract the tooth.
- Hemostasis was achieved with a pressure pack, and postoperative instructions were given.
Surgical Extraction of 38:
The procedure required a more detailed and careful surgical approach due to the impaction:
Step-by-step Surgical Extraction:
- Incision and Flap Elevation:
- A Ward’s incision was made extending from the anterior border of the ramus to the distal of the second molar.
- A full-thickness mucoperiosteal flap was raised to expose the underlying bone
2. Bone Guttering:
- Buccal and distal bone was carefully removed using a round bur under copious irrigation to expose the crown portion.
3. Tooth Sectioning:
- Due to its mesioangular position, the crown was sectioned into two parts for easy removal without damaging the surrounding bone or nerve.
4. Tooth Removal:
- Both sections of the tooth were luxated and removed using elevators.
- The socket was irrigated with saline, and sharp bony spicules were smoothed out.
5. Closure:
- The surgical site was sutured using 3-0 silk sutures.
- Postoperative medications and care instructions were provided.
Postoperative Care:
- Antibiotics and analgesics were prescribed.
- The patient was advised to follow strict oral hygiene, avoid spitting or rinsing vigorously, and maintain a soft diet for a few days.
- Sutures were planned for removal after 7 days.