Abstract: Objective: This article discusses a case of surgical extraction of a buccolingually embedded obstructed mandibular first molar and analyzes the key intraoperative operations and their impact on postoperative recovery. Diagnosis and treatment: Preoperative cone-beam computed tomography (CBCT) was used to assess the location of the obstructed tooth and its relationship with adjacent anatomical structures, and a personalized surgical plan was formulated. During the operation, the main lingual window was opened, combined with buccal auxiliary opening window technique, to gradually debride and split and remove the tooth. Postoperative close follow-up was performed to observe the healing of the extraction socket. Results: No residual dental tissue was seen in the immediate postoperative X-ray examination. On review 3 months after surgery, the patient’s bone in the extraction area was in a remodeled state, indicating that the surgery had achieved a good result. Conclusions: Proper selection of the surgical incision and bone removal technique is crucial for improving the success rate of impacted mandibular first molar extraction in the buccolingual direction, minimizing trauma, and protecting adjacent structures.

Key words: obstructed tooth, mandibular first molar, minimally invasive extraction, electric handpiece, tooth extraction