extraction -SECTIONING EG

Clinician Specialty: Dentist Subjective Patient presents with severe pain and swelling in the lower right quadrant, specifically tooth #46. Pain is throbbing, 7/10, exacerbated by biting. Relevant past dental and medical history: Patient reports a history of recurrent pericoronitis associated with #46. Medical history includes well-controlled hypertension, managed with Amlodipine 5mg daily. No known drug allergies. Assessment E/O findings: Facial asymmetry noted due to swelling in the right submandibular region. Tender to palpation along the angle of the mandible. Reduced mouth opening (30mm). I/O findings: Grossly carious #46 with distal caries extending subgingivally. Significant tenderness to percussion and palpation. Deep periodontal probing depths distally. Surrounding gingiva is erythematous and oedematous. Tooth mobility Grade II. Radiographic findings showing multi-rooted tooth, with significant distal bone loss and periapical radiolucency associated with the distal root of #46. Roots appear slightly curved. Bone level is significantly reduced distally, approximately 5mm below the CEJ. Diagnosis: Irreversible pulpitis with symptomatic apical periodontitis of tooth #46, complicated by acute dentoalveolar abscess. Consent "Risks of extraction discussed including pain, swelling, bleeding, infection, fractured roots, need for sectioning roots, risk of damage to adjacent teeth, sinus exposure (if upper molar), nerve injury (if lower molar), and dry socket. Patient understood and consented." Treatment Local anaesthetic type and amount: 2.2ml of 2% Lidocaine with 1:80,000 Adrenaline (inferior alveolar nerve block and long buccal nerve block). Tooth number isolated: #46 isolated using cotton rolls and a saliva ejector. Details of crown and/or roots sectioned using handpiece and bur: Crown of #46 sectioned mesio-distally using a high-speed handpiece and a long shank fissure bur to separate the mesial and distal roots. Distal root then sectioned buccolingually to aid removal. Details of roots elevated and removed individually: Mesial root elevated using a straight elevator and removed. Distal root then elevated and removed in two parts using various luxators and elevators (coupland elevator #2, Warwick-James elevator straight). Socket curettage and irrigation details: Socket thoroughly curetted to remove granulation tissue and irrigated with normal saline. All sharp bone margins smoothed with a bone file. Haemostasis status: Haemostasis achieved with firm pressure applied using gauze, no active bleeding noted. Any complications or note if root tip left, otherwise state no complications: No complications encountered during the extraction. No root tips left. Post-operative Instructions "Patient given verbal and written post-operative instructions." Analgesia advice including analgesic recommended: Advised to take Ibuprofen 400mg every 6-8 hours as needed for pain, and Paracetamol 500mg every 4-6 hours if pain persists. Avoid Aspirin. Follow-up details including suture removal if applicable or review appointment: No sutures placed. Advised to return for review in one week or sooner if any concerns arise. Other Notes Patient was anxious prior to the procedure, but tolerated it well after reassurance and clear communication. Discussed options for future tooth replacement including implant or bridge, patient to consider and schedule a separate consultation for this.