Impacted wisdom teeth often create multiple problems, not only causing pain themselves but also damaging the neighbouring tooth due to food lodgment and caries. This case illustrates how timely surgical management of an impacted lower right third molar (tooth 48) was combined with the treatment plan for the adjacent second molar (tooth 47).
Patient Information
Age/Gender: Not specified
Medical History: No significant medical history reported
Chief Complaint: Patient complained of pain and food lodgment in the lower right back tooth region for the past 10 days.
Clinical Examination
- Tooth involved: 48 (lower right third molar) – decayed and impacted.
- Tooth 47 (lower right second molar) – carious and tender.
- IOPA X-ray Confirmed impacted and decayed 48 with caries involving 47.
Diagnosis
- Decayed, impacted mandibular third molar (48).
- Deep caries involving the mandibular second molar (47).
Treatment Plan
- Surgical extraction of tooth 48 under local anaesthesia to eliminate pain and prevent further infection.
- Root Canal Treatment (RCT) of tooth 47 is planned after 7 days to preserve the tooth and restore function.
The patient was informed of the prognosis and treatment steps, and consent was obtained.
Surgical Extraction Procedure of 48
Post-Operative: The patient was instructed to: Anaesthesia
- Incision & Flap Reflection
- Bone Removal (Osteotomy)
- Tooth Sectioning
- Tooth Removal
- Socket Management
- Closure
Post-Operative Care
The patient was instructed to:
- Bite on gauze for 30–45 minutes to control bleeding.
- Avoid spitting, rinsing, or smoking for 24 hours.
- Apply cold packs externally to reduce swelling.
- Take prescribed antibiotics and analgesics.
- Eat soft foods and avoid chewing on the surgical side.
- Maintain oral hygiene carefully without disturbing the surgical site.
Follow-Up and Further Treatment
- The patient was recalled after 7 days for review.
- Healing of the extraction site was satisfactory.
- Root Canal Treatment (RCT) of tooth 47 was then initiated to save the tooth and prevent further complications.
Outcome
- Surgical extraction of 48 was successful with uneventful healing.
- Patient’s pain and food lodgment were resolved.
- Tooth 47 was preserved through endodontic treatment, ensuring long-term function.