Dental surgery and tooth extraction

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 (in the case of children's milk teeth).

Stages of post-extraction wound healing

After the removal of a tooth, the post-extraction alveolar fills with blood and forms a clot that will isolate it from the septic environment. This clot must remain in the alveolar because it will ensure the healing of the bone.

Indications and post-extraction care

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

The patient is recommended the following:

- Maintain the supra-alveolar dressing for one hour

- Diet will be resumed after 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 clot formed.

- Mild rinsing with chlorhexidine-based antiseptic solutions may be used.

- Tooth brushing is allowed only from the morning after the extraction day, maintaining the post-extraction wound area.

- Inherent phenomena of post-extraction inflammatory reaction

- Post-operative 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 case of laborious extraction of lower wisdom molars

- Non-absorbable sutures will be removed 7 to 10 days after extraction

Types of dental extractions

Monoradicular tooth extraction

Monoradicular teeth are those that have only one root and are part of the front group (incisors and canines). Extractions of monoarticular teeth are relatively simple and quick procedures. Following an extraction, an implant is usually inserted into the post-extraction socket, 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 bone as possible to support the implant.

Extractions of wisdom teeth

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

Extraction of impacted/semi-impacted wisdom molars

The impacted wisdom tooth is the tooth that fails to erupt on its own and this often causes pain, infection or other complications. The impacted wisdom tooth is only visible on X-rays because it has not yet managed to break through the gum, while the semi-impacted wisdom tooth can be seen clinically because it partially erupts and is visible in the gum. If not extracted in time wisdom teeth can cause crowding of already erupted teeth and can even lead to cysts and 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.