Surgical tooth extraction is also known as open or transalveolar tooth extraction. It is performed in those teeth which are damaged to such an extent that nothing is visible above the gum line or if the tooth is impacted in the bone or in the soft tissue. Tooth can’t be grasped with the forceps so dental surgeon will give an incision that is cut in the gums to move the tooth out of the bone. At times, tooth may need to be sectioned into pieces to remove it. Bone cutting may or may not be required in surgical method of tooth extraction.
Surgical Tooth Extraction Procedure is done in:
1. Impacted Teeth
2. Teeth with extensive caries especially if there are root caries or in cases of large amalgam restorations, surgical tooth extraction is done.
3. Teeth in which roots are widely divergent are indicated for surgical tooth extraction.
4. In case of older patients, dense bone is present which is more calcified and is less likely to expand so surgical tooth extraction is preferred in cases of dense bone.
5. Surgical tooth extraction procedure is done when nothing is visible above the gum line
6. Hypercementosed or ankylosed teeth
7. Any tooth or root near vital structures like maxillary sinus or mandibular canal
Who Performs Surgical Tooth Extraction
Surgical tooth extraction is often performed by a dental surgeon as opposed to a general dentist who mainly performs the simple tooth extraction.
Advantages of Surgical Tooth extraction
1. Increased accessibility and visiblity of the operating site.
2. Avoids unnecessary laceration of adjoining soft tissue
3. Decreased chances of breakage of tooth
4 Less postoperative complications
Before the Surgical Tooth Extraction Procedure
Presurgical assessment of the patient is done which includes evaluation of the level of anxiety, determination of health status and any necessary modification of routine procedures, evaluation of the clinical presentation of the tooth to be removed, and radiographic examination of tooth root and bone. All these four factors are evaluated before surgical tooth extraction procedure.
1. Presurgical Medical Assessment
The oral surgeon will examine the patient’s medical status before the surgical tooth extraction procedure. Patients may have a variety of maladies that require treatment modification before the required surgery can be performed safely.
2. Clinical Evaluation of Tooth for Removal
In the preoperative assessment period, the tooth to be extracted is carefully examined by the oral surgeon. Along with the tooth to be removed, oral surgeon will also assess the condition of adjacent teeth.
3. Radiographic Examination of Tooth for Removal
X-ray of the tooth to be removed is taken. Periapical x-rays provide the most accurate and detailed information concerning the tooth, its roots and the surrounding tissue. Panoramic radiographs are used frequently, but their greatest usefulness is for impacted teeth as opposed to erupted teeth. X-rays tell about the relationship of the tooth to the associated vital structures, Configuration of roots of tooth to be removed and condition of surrounding bone.
Wisdom Tooth indicated for Tooth Extraction
Surgical Procedures are of 5 types, surgical, surgical root, soft tissue, partial bony, full bony. Tooth may be impacted within the soft tissue or may be impacted within the bone partially or completely. If the tooth is impacted in the bone, then bone cutting is required to pull the tooth out.
Surgical Tooth Extraction
Numbing the Tooth
To numb the tooth extraction area, dental surgeon will give some shots of local anesthesia to the patient. During local anesthetic injection, patient will feel prick at the site of injection. Topical anesthesia may also be given onto the site of needle penetration before giving the local anesthetic injection. Lignocaine along with adrenaline is commonly used for numbing the tooth.
In cases of difficult surgical extractions or in patients with dental anxiety, the procedure can be done after giving sedation such as IV conscious sedation or after giving general anesthesia. If conscious sedation or general anesthesia is given to the patient, then they should wear the clothing in which the sleeves can be rolled on or in clothing with short sleeves. This will allow an easy access for the intravenous line which is to be put in the vein. If the tooth extraction is to be done under general anesthesia, then patient should not drink or eat anything for at least six hours before the procedure. After the tooth extraction surgery, arrangements should be made by the patient for a friend or a relative to drive them home.
Procedure for Surgical Tooth Extraction
1. Incision on the Soft Tissue
To provide adequate visualization and access to the tooth, soft tissue and or bone is reflected. Gum tissue or bone may be covering the tooth which will make it difficult for the dentist to access. In such cases, access is obtained by reflecting the soft tissue. Incision is given with the scalpel. Cut is made directly through the gum tissue down to the bone.
2. Bone Cutting
If the tooth is embedded in the bone, then bone cutting is required to expose the tooth. Bone cutting may also be required to remove the bone which is likely to cause obstruction in the extraction of the tooth. Bone cutting can be done with high speed dental drill and bur or bone can be removed with chisel and mallet. While doing bone cutting, sufficient saline or water should be used for irrigation.
Flap raised followed by Bone Cutting to expose the Impacted Tooth
3. Sectioning or division of the Tooth
Sectioning of the tooth can be done with bur or chisel. Bur use is preferred as compared to chisel. Tooth sectioning will conserve the bone removal prior to elevation of tooth and reduces the damage to the adjacent tissues. While doing the sectioning, bur is used in controlled fashion to avoid damage to the vital structures and surrounding tissues.
4. Elevation and Tooth Extraction
Tooth is luxated with elevators and tooth is removed. Heavy elevator such as crane pick may be used to elevate or lever the tooth from the socket. No fragment of tooth should remain in the socket.
After tooth extraction, dental surgeon should check for bone edges. If the bone edges are sharp, then they should be smoothened with bone file.
After tooth extraction, surgical field should be thoroughly irrigated with copious amount of saline solution.
5. Sutures or stitches after tooth extraction
After tooth extraction, the ends of the flap are approximated with sutures or stitches. Sutures are further of 2 types, resorbable sutures and non-resorbable sutures. Resorbable sutures are gut, polyglycolic acid and copolymer of glycolic and lactic acid. Non-resorbable suture material includes silk, nylon, polypropylene. Non-resorbable sutures are monofilamentous, polyfilamentous or both.
After giving the stitches, wet cotton gauze is kept on the tooth extraction socket and patient has to bite down on that gauze pack for next 30-60minutes. This is done to achieve hemostasis that is to stop the bleeding after tooth extraction and for clot formation to take place.
After surgical tooth extraction procedure, patient has to follow certain Do’s and Don’ts after Tooth Extraction.
Take Rest- Your oral surgeon may advise you that you can get back to work after 3 hours but it is better if you take rest for a day after surgical tooth extraction.
Don’t spit minimum of 24 hours after surgical tooth extraction.
Don’t smoke for 48 hours after surgical tooth extraction.
Avoid sucking of any types.
Don’t take solids and take liquid and soft diet after surgical tooth extraction.