DENTAL SURGERY

What is tooth extraction?

Tooth extraction is a surgical procedure that takes place in the dentist's office to remove a tooth that can no longer be treated.

To perform a tooth extraction, an X-ray must first be taken. The operation is performed after the administration of a local anaesthetic, either injectable or in the form of a spray (if we are talking about children's milk teeth).

Monoradicular tooth extraction

Monoradicular teeth are those with a single root canal and are part of the front group (incisors and canines). Extractions of monoarticular teeth are relatively simple and quick procedures. Following such extractions, an implant is usually inserted into the post-extraction alveolus, which can sometimes be done in the same session. The dental implant must be inserted as soon as possible after the extraction to have as much straight bone as possible, as this will be the support for the implant.

Extractions of wisdom teeth

Wisdom molars are extracted if they erupt in the wrong position and start to push into neighbouring teeth or when they cause pain. Dental implants are not recommended in place of extracted wisdom molars.

Included / semi-included wisdom molar extraction

An impacted wisdom tooth is a tooth that fails to erupt on its own, which can frequently cause pain, infection or other complications. It is only visible on X-rays because it has failed to break through the gum. In contrast, the semi-enclosed wisdom molar can be seen clinically, having partially erupted and being visible in the gum. If wisdom molars are not extracted promptly, complications such as superinfection, damage to surrounding tissues or inadequate loading of already erupted teeth may occur. In some cases, this can even lead to the formation of cysts or tumours.

Extraction of pluriradicular teeth

Pluriradicular teeth are those that have two or more roots and are more difficult to extract. Their extraction is more laborious and often involves cutting the teeth and removing them in fragments.

Extraction of impacted or semi-impacted canines

Upper canines are the last teeth to appear on the arch and their eruption process is affected by the presence or lack of space for their correct alignment. Therefore if the space on the arch is no longer adequate for their appearance, canines can erupt in the wrong positions or even remain embedded in the bone. With an orthodontic appliance, it is often possible to straighten them orthodontically and bring them into the correct position on the arch, as the canine is one of the most important teeth. When orthodontic straightening is not possible it is recommended to extract the canines to avoid complications (infections or cysts).

Extraction by alveolotomy

Alveolotomy is a surgical method of extraction by partially exposing the roots after removing part of the alveolar bone.

Alveolotomy is indicated in the following situations:

• Roots located deep interalveolar
• Deformed roots or dentoalveolar ankylosis
• Teeth with divergent or convergent roots
• Deep root remnants remaining for a long time intraosseous

Extraction of temporary teeth

Extraction of temporary teeth is much easier than permanent teeth because their roots are mostly resorbed. In this case, the extraction is done with spray anaesthesia most of the time. There is however a particular situation in temporary molars when root resorption is partial and root debris gets stuck between the crown of the permanent tooth and the alveolar walls. In this case, extraction is necessary because the root fragment cannot self-remove, causing eruption disorders.

Following tooth extraction, the alveolar socket fills with blood, forming a clot that serves as a protective barrier against infection. This clot must remain undisturbed in the alveolar socket, as it facilitates bone healing.

After simple tooth extraction, it is recommended to apply a dressing over the post-extraction socket.

The patient is recommended to do the following:

• Maintain the supra-alveolar dressing for one hour.
• The diet will be resumed after the removal of the dressing, but on the day of surgery, it will be semi-liquid at room temperature.
• It is recommended to chew food on the opposite hemiarch to avoid post-extraction wound injury.
• Avoid rinsing the mouth and drinking carbonated beverages in the first days after extraction to avoid dislodging the clots that have formed.
• Mild rinsing with chlorhexidine-based antiseptic solutions may be used.
• Tooth brushing is allowed only in the morning after the extraction day, maintaining the post-extraction wound area.

• Postoperative swelling may last 3–6 days and can be reduced with cold compresses applied to the cheek in the extraction area.
• Post-extraction pain is generally moderate, and the usual anti-inflammatory and pain relievers are recommended.
• Moderate trismus may be present in cases of laborious extraction of lower wisdom molars.
• Non-absorbable sutures will be removed 7 to 10 days after extraction.