Severe pain in the lower left jaw, increased discomfort when biting, and the feeling that a tooth is rising above the gum line are warning signs that your wisdom tooth may be causing serious issues. In particular, if you are dealing with a wisdom tooth that is growing toward the cheek, angled at 45 degrees, or pressing on the nerve, it’s crucial to seek timely examination and treatment to avoid severe complications. This article will explore a specific clinical case to help you better understand the wisdom tooth extraction process, especially in complex situations.

The patient's initial condition

A 45-year-old male patient visited the dental clinic with severe pain in the lower left jaw, experiencing constant discomfort that intensified when biting and causing difficulty during chewing. He also reported a history of poorly controlled high blood pressure, an important factor that requires special attention in any medical or dental procedure.

Clinical examination showed that the lower left wisdom tooth (#48) was mesially impacted, with the crown tilted forward and pressing against the adjacent tooth (#47). Tooth #47 exhibited slight mobility, pain upon percussion, and no response to pulp vitality testing. The surrounding gum tissue was swollen and red, and a periodontal pocket with a depth of 4 mm was detected.

The X-ray results clearly showed bone loss on the distal surface of tooth #47, extending into the furcation area. Tooth #47 also had a large subgingival cavity at the level of the alveolar crest, accompanied by periapical infection. Tooth #48 was mesially impacted, with hook-shaped roots, and was surrounded by dense mandibular bone, which made extraction by conventional methods more difficult.

Patient’s Concerns and Expectations

The patient’s main goal was to end the persistent pain that had seriously affected his sleep and daily activities. He was also concerned about the possibility of preserving tooth #47, which plays an important role in chewing function. In addition, due to his history of high blood pressure, the patient expressed concern about potential complications that might occur during the extraction process.

Detailed Diagnosis from the Specialist

Based on the clinical examination and X-ray results, Dr. Chu Thi Thu Huong diagnosed the following: The lower left wisdom tooth (#48) was mesially impacted, causing trauma to the adjacent second molar (#47). Tooth #47 presented with acute periapical inflammation due to a distal carious lesion, along with bone loss on the distal surface and furcation bone resorption, giving it a poor prognosis for preservation. Additionally, the dense mandibular bone in the area around tooth #48 increased the complexity of the case. The patient’s blood pressure reading of 180/100 mmHg at the clinic indicated uncontrolled hypertension, which required careful management before performing any dental extraction procedure.

The main cause was identified as the mesially impacted wisdom tooth (#48), which created a space where food debris accumulated, leading to the formation of a distal carious lesion and subsequent periodontal inflammation affecting tooth #47.

Optimal Treatment Plan

After the professional consultation, the doctor proposed a treatment plan that included the extraction of both teeth #48 and #47. This decision aimed to completely remove the source of infection and the tooth with a poor prognosis. The Piezotome extraction technique was selected to assist in the procedure.

Advantages of the Method:

• Completely resolved the pain and infection.
• Maximized preservation of the alveolar bone, creating a favorable foundation for future dental implant placement to replace tooth #47.
• Minimized postoperative bleeding and swelling thanks to the use of the Piezotome technique.

Limitations to Note:

• Temporary loss of tooth #47 may slightly affect chewing function during the initial recovery phase.
• It is necessary to closely monitor and control the patient’s blood pressure throughout the entire treatment process.

Standard Medical Procedure

1. Preparation: The patient’s blood pressure was carefully checked before the procedure. All necessary equipment and medication for blood pressure control were prepared in advance. The patient’s health condition was closely monitored before, during, and after surgery to ensure maximum safety throughout the process.
2. Anesthesia: Articaine was used as the local anesthetic, while formulations containing high levels of adrenaline were avoided to prevent an increase in blood pressure.
3. Extraction of Tooth #48: The dentist used the Piezotome device to precisely section the bone, separate the periodontal ligament, gently expand the socket, and safely remove the tooth.
4. Extraction of Tooth #47: After carefully evaluating the bone condition and root structure, the dentist proceeded with the extraction, completely removing the inflamed tissue while preserving the remaining healthy bone.
5. Socket Treatment: The inflamed granulation tissue was thoroughly cleaned, and the extraction socket was irrigated. A hemostatic agent was placed, and the wound was closed using resorbable sutures.
6. Postoperative Care Instructions: The patient was advised to follow a soft-food diet, maintain gentle oral hygiene, monitor blood pressure at home, and adhere to the scheduled follow-up appointments for postoperative evaluation and care.

Result 

Immediately after surgery, the patient’s pain was significantly reduced. Thanks to the Piezotome technique, postoperative swelling and bleeding were minimal, and no complications were recorded. The patient expressed great satisfaction with the treatment outcome — the pain was completely resolved, and he felt reassured about the long-term plan for restoring chewing function.

Post-Extraction Results (Based on Radiographic Images) 

Professional Summary and Doctor’s Advice

A mesially impacted wisdom tooth, especially when tooth #48 presses against tooth #47, is one of the most common causes of serious complications such as bone loss, hidden caries, retrograde pulpitis, and periodontitis. If only the wisdom tooth is extracted without treating the damaged tooth #47, the risk of reinfection and treatment failure is very high. Therefore, the indication to extract both teeth in this case is completely appropriate.

The application of Piezotome technology in tooth extraction offers several outstanding advantages: it allows for precise operation with minimal trauma, preserves the alveolar bone—a crucial factor for future implant placement—and significantly reduces swelling, pain, and complications. This method is particularly well-suited for patients with underlying health conditions such as hypertension, ensuring both safety and comfort throughout the surgical procedure.

Conclusion

This clinical case once again highlights the importance of regular dental check-ups, which allow for the early detection of impacted wisdom teeth—a potential cause of many serious complications affecting both oral and overall health. Choosing an advanced extraction technique such as Piezotome and having the procedure performed at a trusted dental clinic ensures maximum safety, minimizes trauma, and delivers the most effective treatment outcome.

If you’re experiencing similar symptoms or have any concerns about your oral health, don’t hesitate to contact Herident Dental Clinic. With deep expertise in orthodontics, cosmetic restorations, and dental implants, our team of experienced dentists is always ready to provide thorough consultation, examination, and the most suitable treatment solutions — helping you achieve a healthy and confident smile. Book your appointment today to receive professional care and personalized support from our dental experts at Herident.