Patient Complaint:
A patient reported to our clinic with pain in the lower left back tooth region. The discomfort had gradually increased over the past few days, making it difficult for the patient to chew properly and open their mouth fully.
Clinical Examination:
Upon intraoral examination, tooth 38 (lower left third molar) was found to be impacted partially erupted and tilted in such a way that it was pressing against the adjacent tooth. There was mild swelling in the surrounding soft tissue and tenderness on palpation.
Investigations:
An OPG (Orthopantomogram) was advised to evaluate:
- The angulation and depth of impaction.
- Relation of the roots with the inferior alveolar nerve canal.
- Proximity to adjacent structures.
The radiograph confirmed a mesioangular impaction of tooth 38, with no signs of cystic lesion or nerve involvement.
Treatment Plan:
The patient was explained about the condition and the need for a surgical extraction. After obtaining informed consent, the procedure was planned under local anaesthesia.
Surgical Procedure:
Step 1: Anaesthesia
- Local anaesthesia administered using Inferior Alveolar Nerve Block with 2% lignocaine with adrenaline.
- Buccal and lingual infiltration given for added soft tissue anaesthesia.
Step 2: Asepsis and Access
- The surgical site was cleaned and draped.
- A full-thickness mucoperiosteal flap was raised using a scalpel to expose the underlying bone.
Step 3: Bone Guttering
- A straight surgical handpiece with a bur was used to carefully remove the overlying bone (buccal and distal bone guttering) to access the crown of the tooth.
Step 4: Tooth Sectioning
- The impacted tooth was sectioned mesiodistally to separate the crown from the roots.
- Each section was gently mobilized using an elevator to reduce trauma to the surrounding bone and nerve.
Step 5: Tooth Removal
- Both the crown and root segments were removed carefully.
- The socket was inspected to ensure no root tips or debris remained.
Step 6: Irrigation & Closure
- The surgical site was irrigated thoroughly with normal saline.
- A gauze pack was placed temporarily to control bleeding.
- The flap was repositioned and sutured using resorbable sutures.
Post-Operative Instructions:
The patient was advised:
- Take prescribed antibiotics and analgesics as directed.
- Apply cold compress intermittently for 24 hours to reduce swelling.
- Avoid spitting, rinsing, or using a straw for the first 24 hours.
- Maintain oral hygiene using warm saline rinses after 24 hours.
- Soft diet and adequate fluid intake.