There are various procedures of tooth extractions depending upon the case to case. The dentist decides the best way after clinical examination and taking x-ray to see the position and condition of the tooth to be extracted and accordingly decides whether the tooth can be extracted simply or some surgical procedure for tooth extraction has to be adopted. There are two ways of extracting or pulling out the teeth. These two ways are:
1. Simple extractions
2. Surgical extractions
In simple tooth extraction cases, after giving the local anesthesia, the tooth is extracted / pulled out with the dental forceps. No afterward complications are expected if patient follows the post tooth extraction instructions given by the dentist.
Simple Tooth extraction
Simple tooth extractions are also known as closed extractions or intraalveolar extractions or forceps extractions. In simple tooth extraction cases, after giving the local anesthesia, the tooth is extracted / pulled out with the dental forceps. So they are known as forceps extractions. They are known as intra-alveolar extractions because no bone cutting is required and the tooth can be just removed from the socket with the help of forceps. No afterward complications are expected if the patient follows the post tooth extraction instructions given by the dentist. Simple extractions are performed in those teeth in which much of crown of the tooth is in good condition. General dentists commonly do the simple tooth extractions. Most of the times, there is no requirement of sedation or anti-anxiety drugs in doing simple tooth extractions. The tooth is grasped with forceps in this and then the tooth is loosened by moving the forceps back and forth and then the tooth is pulled out. Dental Elevators may be used for loosening the teeth.
Surgical Tooth Extractions
They are also known as open extractions or transalveolar extractions. Unfortunately all the teeth cannot be pulled out easily. In some cases the tooth is damaged to that extent that nothing is visible above the gum line or in some cases due to infection or root canal treatment the tooth becomes so brittle that the crown breaks as soon as it is held by the forceps leaving behind the root part. In such cases surgical extraction has to be done. In this type of extractions, incision is given on the gums and the flap is raised to expose the embedded part of the root of the tooth which is then removed. But sometimes bone has to be cut to fully remove the roots of the tooth. In case of surgical tooth extractions, the procedure is done under injections of local anesthesia and conscious sedation may also be given. In patients who are very apprehensive or have special medical conditions and in young children, the procedure may be done under general anesthesia.
If the tooth is being pulled out after receiving conscious sedation, then steroids may be given to reduce the swelling which occurs after the tooth extraction.
Surgical extractions are mainly performed by the oral surgeons and incision on the gums and/or bone cutting is required in these kinds of extractions. It is a more invasive procedure than the simple extractions. It is done in those teeth which don’t have much of tooth structure left and nothing much is visible above the gum line. There is comparatively more postoperative pain in cases of surgical extractions. Surgical procedures can be of 5types: Surgical, surgical root, soft tissue, partial bony and full bony.
Impacted Teeth Extractions
Impacted teeth are those teeth which are embedded and do not erupt in the oral cavity. These teeth create lot of problems and have to be extracted. Most commonly seen impacted teeth are the lower third molars (wisdom teeth) followed by the upper third molars. Upper canines are also impacted in many cases.
The impaction can be soft tissue impactions or bony impactions.
If it is soft tissue impaction then the incision has to be given in the soft tissue above the tooth and then like simple extraction it can be pulled out by using the forceps. But if it is bony impaction then the bone has to be cut and sometimes the tooth is also sectioned.
The impaction can be vertical, horizontal or angular depending about the angle of the tooth. Depending on the angle of the tooth, the impactions can be Mesio-angular or Disto-angular. The most difficult kind of impactions is Disto angular impactions. Mesio-angular impacted cases are comparatively easier to remove as compared to the Disto-angular impactions.
Angular Partial Eruption
If all the four wisdom teeth are to be removed, then the upper teeth should be removed first and then the lower teeth should be removed.
Wisdom teeth can be –
2. Soft tissue impacted
3. Partial bony impacted
4. Full-bony impacted
Wisdom teeth are said to be erupted when they are already in the mouth. They are called as soft tissue impacted when they are present under the gums. They are called as partial bony when they are partially stuck in the jaw and are called as full bony when they are completely in the jaw.