Surgical Extraction of tooth #38

Patient History 

A male patient, 28 year old, came to the dental OPD with a complaint of pain in lower left 3rd molar. There was no significant medical history. Consent was obtained. The tooth was carious and the mesial root was curved as seen on the radiograph. The tooth was completely erupted.

Anesthesia 

Inferior Alveolar Nerve Block and Long Buccal Nerve Block were given initially, then Intraligamental was used in the middle of the procedure. 

Incision

Releasing incision was given on distal side and a clavicular incision on mesial side. A three sided flap was raised. This improved visibility and we were able to visualize the tooth better. 

The tooth was carious and mesial root was curved. The roots were not getting luxated with straight elevators. Cowhorn forceps were used before sectioning. The forceps engage at the furcation area. This caused the crown to fracture near the furcation area, as seen on the second radiograph. 

Bone removal 

Buccal bone was removed (buccal guttering) with a slow speed handpiece and tungsten carbide surgical bur. The furcation area was broken with the handpiece and this separated the roots. 

Tooth removal

The roots were removed separately. A straight elevator was used to remove the mesial root and a cryer was used to remove the distal root. 

Cleaning the socket 

Vigorous irrigation was done to remove any root fragments.

Suturing

Single interrupted sutures were placed, one on mesial side of second molar and one at the releasing incision area.

Control bleeding

A gauze pack was placed to control bleeding. 

Post Op Instructions were given

• Give pressure pack for 1 hour 

• Application of ice 

• Soft diet for the first 2 days 

• 1st dose of analgesic given after 1 hour 

• Avoid gargling, using a straw, spitting, smoking.

• Warm water gargling after 24 hours 

• Inform patient that swelling is normal and it will subside in 3 to 4 days or even about a week 

• Suture removal needs to be done after 7 days 

(Best to write the instructions on patient slip in notes before discharge)

Medication given 

• Tab. Panadol 2 tablets TDS or Tab. Femidol Plus 2 tabs TDS 

• Tab. Amoxil 1 tab TDS 

Case done with Dr. Muhammad Ahmed at Farooq Hospital, Westwood Branch Lahore. 

Patient History 

A male patient, 28 year old, came to the dental OPD with a complaint of pain in lower left 3rd molar. There was no significant medical history. Consent was obtained. The tooth was carious and the mesial root was curved as seen on the radiograph. The tooth was completely erupted.

Anesthesia 

Inferior Alveolar Nerve Block and Long Buccal Nerve Block were given initially, then Intraligamental was used in the middle of the procedure. 

Incision

Releasing incision was given on distal side and a clavicular incision on mesial side. A three sided flap was raised. This improved visibility and we were able to visualize the tooth better. 

The tooth was carious and mesial root was curved. The roots were not getting luxated with straight elevators. Cowhorn forceps were used before sectioning. The forceps engage at the furcation area. This caused the crown to fracture near the furcation area, as seen on the second radiograph. 

Bone removal 

Buccal bone was removed (buccal guttering) with a slow speed handpiece and tungsten carbide surgical bur. The furcation area was broken with the handpiece and this separated the roots. 

Tooth removal

The roots were removed separately. A straight elevator was used to remove the mesial root and a cryer was used to remove the distal root. 

Cleaning the socket 

Vigorous irrigation was done to remove any root fragments.

Suturing

Single interrupted sutures were placed, one on mesial side of second molar and one at the releasing incision area.

Control bleeding

A gauze pack was placed to control bleeding. 

Post Op Instructions were given

• Give pressure pack for 1 hour 

• Application of ice 

• Soft diet for the first 2 days 

• 1st dose of analgesic given after 1 hour 

• Avoid gargling, using a straw, spitting, smoking.

• Warm water gargling after 24 hours 

• Inform patient that swelling is normal and it will subside in 3 to 4 days or even about a week 

• Suture removal needs to be done after 7 days 

(Best to write the instructions on patient slip in notes before discharge)

Medication given 

• Tab. Panadol 2 tablets TDS or Tab. Femidol Plus 2 tabs TDS 

• Tab. Amoxil 1 tab TDS 

Case done with Dr. Muhammad Ahmed at Farooq Hospital, Westwood Branch Lahore.