A 20 year old male patient reports-with the chief complaint of recurrent pain and swelling on the lingual side of the mandibular third molar area on the right side. The dental history of the patient revealed that lower right third molar was extracted by a local dentist and following this extraction, after about period of two weeks, the patient developed pain and swelling on the lingual side of the ramus. No further detailed dental history was abailable either from the patient or from the treating dentist. There were no clinical symptoms of dysesthesia of the lower lip or tongue on right side. The medical history of the patient was non-contributory.
The clinical examination was essentially restricted to intra-oral examination only. The intra-oral clinical examination revealed an absent lower third molar and tenderness on lingual side of lower third molar area on palpation.
A lateral oblique view of the mandible (Right Side) was taken and it showed an incompletely developed third molar in an unusual position raising doubts about its real position- in the ramus or in the surrounding soft tissues. A CT scan was ordered and the tooth was found lying lingual to the ramus below the mylohyoid muscle.
Considering the fact that the displaced tooth was causing pain and swelling because of infection, a decision was made to retrieve the displaced tooth. Reports of the routine preoperative blood and urine analysis were within normal limits.
The procedure was performed under local anaesthesia supplemented with premedication of Injectable Atropine (0.6 mg) and injectable Dexamethasomne (8 mg) given intra-muscularly and an oral tablet of Triazolam (0.5mg) given half an hour before surgery. A broad mucoperiosteal flap extending from the ramus to the distal surface of first pre-molar was raised on lingual side, the displaced tooth was pushed below the mylohyoid muscle which projected into the incision. Fibers of the mylohyoid muscle were split through blunt dissection, exposing the tooth. The tooth was grasped with a hemostat and delivered out of the mouth. The wound was irrigated with the copious amount of saline and antibiotic of Betadine (povidone-iodine 1%). Bleeding was arrested and subsequently, the wound was closed by interrupted black silk sutures. The patient was put on a course of an antibiotic (Cap. Amoxicillin 500mg.q8h) and an analgesic (Tab. Ibuproffen 400mg q8h) for a period of seven days. The postoperative course was uneventful. The surgical specimen of the retrieved displaced tooth was found to be non-carious tooth with incompletely formed roots.
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