Patient Profile
- Medical History: Known case of Diabetes Mellitus and Hypertension
- Chief Complaint: Severe pain in the lower left back tooth region for the past 2–3 days
Clinical Examination
On intraoral examination:
- Tooth 38 (lower left third molar) was found to be grossly decayed
- The tooth was tender on percussion (severe tenderness to vertical pressure)
- Surrounding soft tissues showed signs of inflammation
- Severe TOP positive (Test of Percussion)
Due to the extensive decay and patient discomfort, further imaging was warranted.
Radiographic Evaluation
- IOPA (Intraoral Periapical Radiograph) was advised and revealed:
Treatment Plan
Considering:
- The non-restorability of the tooth
- Patient’s systemic condition (diabetes & hypertension)
- Persistent pain and inflammation
Planned treatment: Surgical extraction of 38 under local anesthesia
Surgical Procedure Details
Pre-operative Preparation:
- Patient was medically evaluated and fitness for dental extraction obtained
- Blood pressure and blood sugar levels were within acceptable limits on the day of the procedure
- Informed consent was taken
- Antiseptic mouth rinse with chlorhexidine prior to surgery
Step-by-step Surgical Procedure:
1. Local Anesthesia:
- Administered Inferior Alveolar Nerve Block (IANB) with 2% lignocaine with 1:100,000 adrenaline
- Long buccal nerve block given for soft tissue anesthesia
2. Aseptic Technique:
- Area cleaned and draped
- Full aseptic protocol followed
3. Incision and Flap Elevation:
- A mucoperiosteal flap was raised using a no. 15 blade
- Posterior releasing incision made to allow adequate access
4. Bone Guttering:
- Buccal and distal bone around the tooth was carefully removed using straight surgical bur with copious saline irrigation
5. Tooth Sectioning:
- Due to its gross decay and to avoid excessive force, 38 was sectioned into mesial and distal roots
- Roots were luxated and extracted one at a time with minimal trauma
6. Socket Debridement:
- Socket was thoroughly curetted to remove granulation tissue and debris
- Irrigated with normal saline and betadine
7. Hemostasis and Closure:
- Hemostasis achieved with pressure pack
- Flap repositioned and sutured with 3-0 silk sutures
- Post-operative instructions given
Post-Operative Care
- Medications Prescribed:
- Instructions on:
- Follow-up scheduled after 7–10 days for suture removal and healing assessment
Outcome
The extraction was successful and uneventful. The patient was monitored for signs of infection or delayed healing due to systemic conditions. On follow-up, satisfactory healing was noted, and the patient reported relief from pain.