Dental extractions
Tooth extraction is a common procedure in dentistry, necessary when a tooth cannot be saved by other treatment methods. Whether it’s a deep infection, advanced decay or teeth that don’t have enough space to erupt properly, extraction becomes the solution to prevent complications and maintain oral health.
Extractions are practiced for several reasons:
- teeth with extensive corono-radicular destruction (caries) that can no longer be restored by fillings or prosthetic means;
- when a tooth is longitudinally or extensively subgingival fractured and can no longer be treated;
- teeth with acute periodontitis and high mobility;
- gangrenous teeth complicated by apical periodontitis (periapical granulomas, cysts) in which conservative endodontic/surgical treatment (by root tip resection) is not indicated or has failed;
- tooth decay has totally affected the tooth;
- a large part of the tooth and jawbone has been destroyed by infection;
- extractions for orthodontic purposes, when alignment of the teeth is not possible due to crowding on the dental arch, a tooth considered most unimportant will be extracted;
- teeth in vicious positions that affect the normal development of the other teeth;
In some cases, it may be possible to proceed to extraction by alveolotomy (milling a part of the maxillary or mandibular bone). This surgical technique is practiced if an ankylosis of the tooth to be extracted is observed, thus avoiding fracture of the cortical bone.
Types of tooth extraction:
Different types of dental extractions can be performed in the Doctor White clinic, which can be categorized according to the position of the tooth, the number of dental roots, the strength of the teeth and the complexity of the procedure.
Monoradicular tooth extraction
Extraction of monoradicular (single-rooted) teeth is generally a simple procedure, performed under local anesthesia, using traditional extraction instruments. Monorods include all front teeth (incisors and canines), as well as premolar teeth (except for the first premolar on the upper arch, which may have more than one root).
Multiradicular tooth extraction
A procedure for the removal of teeth with more than one root, considered to be of higher complexity, requiring the teeth to be sectioned into several fragments and these fragments removed one at a time. The category of multirooted teeth includes all molars and in some cases the first premolar on the upper arch.
Extraction of wisdom tooth (impacted/partially impacted molars)
Extraction of wisdom teeth (wisdom molars) can be performed prophylactically, when there are no complications associated with the eruption of wisdom teeth to avoid potential future infections, or therapeutically, when wisdom teeth erupt incorrectly and cause local pain or infection. In contrast to dental extractions performed on other molars, where dental implants are recommended to replace the lost tooth, dental implants are not performed on wisdom molars.
Impacted or partially impacted teeth are those teeth that either fail to erupt on their own or erupt only partially, causing multiple symptoms for patients, such as dental pain or infection. Complications associated with incompletely erupted teeth can be eliminated by tooth extraction.
Dental Extraction Procedure:
The tooth extraction procedure varies depending on the complexity of the case and can be simple or surgical. Each stage of the process is crucial to the success of the procedure and the patient’s comfort.
Simple Extraction Process
Anesthetizing the area: The first step in simple extraction is to ensure patient comfort by anesthetizing the area where the extraction will be performed. Local anesthetic is injected into the tissues surrounding the tooth to block pain sensations, allowing the patient to remain awake and relaxed during the procedure. It is important for the patient to communicate any sensations of discomfort to allow the anesthetic dose to be adjusted if necessary.
Tooth loosening and removal: After the area has been anesthetized, the dentist will use specific instruments to detach the tooth from the surrounding tissues. The dental elevator is used to create space and mobilize the tooth, and the dental forceps to grasp and extract the tooth from the socket. The patient may feel pressure but not pain. If the tooth is difficult to extract, it may be necessary to apply additional force or use special techniques to ensure a complete and safe extraction.
Surgical Extraction Process
Incisions and bone removal: In surgical extraction, access to the tooth is gained by making incisions in the gum and, if necessary, removing the bone surrounding the tooth roots. This step is crucial in the case of impacted teeth or teeth with abnormal positions. The surgeon may use special drills to remove the bone and expose the roots of the tooth, making extraction easier. The process requires precision and care to minimize the impact on neighboring structures and to ensure optimal healing.
Sectioning and removal of the tooth: In some cases, the tooth cannot be extracted in its entirety and needs to be sectioned into several parts. This technique is especially used for impacted wisdom molars or teeth with multiple roots that are strongly anchored in the bone. The dentist or surgeon will use special instruments to cut the tooth into smaller sections, making it easier to remove each part individually. This approach reduces the risk of damaging surrounding tissues and allows for a more controlled and less traumatic extraction. After sectioning, each fragment is carefully removed, ensuring that the entire tooth structure has been removed from the socket.
Care after Extraction
Tampon insertion and bite pressure: After tooth extraction, proper tampon insertion and adequate bite pressure are essential for blood clot formation. The blood clot protects the open hall and is the first step in the healing process. The patient is instructed to bite firmly, but gently on the gauze to control bleeding and promote clot stabilization. It is important that the gauze is kept at the extraction site for a period recommended by the doctor, usually several hours, and changed if it becomes saturated with blood.
Sutures and wound closure: In cases where an incision was required or where the extraction was more complex, sutures may be necessary to close the wound. Sutures help keep the tissues in the correct position for healing and may be resorbable or may require removal at a subsequent visit. Your doctor will provide specific instructions about caring for the sutures and the affected area to prevent infection and promote fast and effective healing.
Recovery and Care after Dental Extraction
After extraction you should expect some pain and discomfort. Painkillers and antibiotics are recommended as appropriate. Blood clots form in the first 24 hours. Sometimes it helps to apply an ice pack to the face in 20-minute intervals. A dairy-free diet is recommended (the area may ferment) for 3 days and food and drink should be at room temperature. Highly strenuous activities should be given up on the post-extraction day.
It is not recommended to smoke, drink alcohol or rinse your mouth profusely in the first days after extraction.
After extraction the area may bleed for a few minutes or a few hours, depending on the individual patient’s body. If you have heavy bleeding that occurs spontaneously a few hours after it has stopped or the day after the extraction, you should see your doctor again.
The swelling of the area where the extraction took place will swell shortly after the operation, this is normal and is due to postoperative edema, this is a stage of healing.
Generally the recovery period takes 5-10 days until the sutures are removed.
Sutures can be removed after 7-10 days.
