Chief Complaint

  • Patient reported pain in the lower left back tooth region for the past 3–4 days.
  • Complained of swelling in the same area.
  • Pain was dull and continuous, aggravated on chewing.

Medical History

  • No known systemic illness or allergies.
  • No medications taken.

Clinical Examination

  • Visible localized swelling and inflammation of the gums in the region of tooth 38.
  • Impacted tooth 38 (partially visible or not erupted).
  • Surrounding tissues tender to palpation.
  • No pus discharge or trismus noted.

Investigations

  • Orthopantomogram (OPG) advised to assess
  • Radiographic Findings

Diagnosis

  • Pericoronitis due to impacted third molar (tooth 38).
  • Associated local soft tissue swelling.

Treatment Plan

  • Surgical extraction of impacted tooth 38 under local anaesthesia.
  • Pre-operative antibiotic and analgesic cover prescribed.

Surgical Procedure – Step-by-Step

1.Pre-operative Protocol

  • Patient explained the procedure and informed consent obtained.
  • Extraoral skin prep with povidone-iodine.
  • Intraoral rinse with chlorhexidine.

2. Anaesthesia

  • Inferior alveolar nerve block with 2% lignocaine + adrenaline.
  • Buccal and lingual nerve blocks administered for complete regional anesthesia.

3. Incision & Flap Reflection

  • A ward’s incision (or modified triangular flap) made on the buccal aspect.
  • Full-thickness mucoperiosteal flap raised to expose the underlying bone and impacted tooth.

4. Bone Guttering

  • Buccal bone removed using straight handpiece and bur under copious saline irrigation.
  • Adequate bone guttering done to visualize the crown of the tooth

5. Tooth Sectioning (if required)

  • Tooth sectioned in halves or multiple pieces to minimize trauma to surrounding structures.
  • Sections gently elevated and removed using elevators and forceps.

6. Socket Debridement

  • Thorough curettage of the extraction socket.
  • Irrigation with normal saline and betadine.

7. Hemostasis & Closure

  • Bleeding controlled with gauze pressure.
  • Flap repositioned and sutured using 3-0 silk sutures.
  • Post-op gauze given for 30 minutes compression.

Post-operative Instructions

  • Ice application for first 24 hours to reduce swelling.
  • Soft diet for 48 hours, avoid spitting or straw use.
  • Continue antibiotics and painkillers as prescribed.
  • Rinse with warm saline/chlorhexidine after 24 hours.
  • Suture removal advised after 7–10 days.

Follow-Up & Outcome

  • Patient reviewed on Day 7:

Key Takeaway

  • sImpacted third molars can lead to pericoronitis, pain, and swelling if not treated timely.
  • Proper imaging and technique are critical for safe and effective surgical extraction.
  • Patient education and post-op care help in uneventful healing.

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