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.

  1. 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.

  2. Don’t spit minimum of 24 hours after surgical tooth extraction.

  3. Don’t smoke for 48 hours after surgical tooth extraction.

  4. Avoid sucking of any types.

  5. Don’t take solids and take liquid and soft diet after surgical tooth extraction.


Leave Comment


  • George Williams, D.D.S.

    George Williams, D.D.S. 17 - April - 2015, at 11:15 AM

  • In some cases, a nonsurgical extraction may hurt worse than a surgical extraction. I am referring to post-operative pain, since anesthesia prevents pain during the procedure. If the bone is very dense, traumatic expansion of the bone may cause pain that lingers, whereas, having the surgeon simply make an incision to get better access might enable him to remove the tooth with less trauma during the procedure. The most painful postoperative pain I have seen is with teeth that were erupted enough that the dentist attempted a routine extraction, but the tooth broke on account of the fact that there was too much resistance to removal. Since the dentist can control where the tooth is cut, but not where it breaks, a tooth that is broken during a routine extraction that proved too difficult, can hurt worse post-op than it would if the extraction were simply done as a surgical procedure from the beginning. YOu see, roots left from a tooth broken during an attempt to remove the tooth routinely still have to be removed, and are harder to get to than they would be had the dentist cut the tooth as his judgment dictates, rather than having it break on its own.

  • Dr.Ritz

    Dr.Ritz 06 - December - 2012, at 22:47 PM

  • Hi Raymond,If a molar is broken at the gumline,the dentist can always do a root canal treatment, put dental posts in and do a dental crown without having to resort to a tooth extraction.Unless there is something else wrong with it. Maybe there is a crack or something else. If you're suspicious that your dentist is too eager to extract it, ask for a second opinion somewhere.Different dentists have different attitudes about extracting teeth. There are many who seem to give up on a tooth too easily,but others will try hard to save them.A molar broken at the gumline is easier to restore than a front tooth, because there are several roots to the molar, and the dentist can put in a couple of posts at different angles,to help hold the crown on.Try saving your natural tooth.I hope this is helpful.Good luck!!!

  • Raymond

    Raymond 06 - December - 2012, at 13:54 PM

  • My tooth is broken in an awkward way. Half is fully exposed and the other half is under the gum. Is it more likely that I'll require surgery? The tooth is a molar.

  • Dr.Ritz

    Dr.Ritz 04 - December - 2012, at 23:39 PM

  • Hi SKY,Stitches are not always necessary for most extractions.It is more usual where a large flap of gum has been lifted up or if multiple teeth are extracted at the same session.With a single extraction the gum is not loose enough to pull across the wound. Stitches have no bearing on whether you get a dry socket or not. Nor are you likely to get any post-op infection.The mouth does a good job of healing by itself.Hope that helps.Good luck!!

  • Sky

    Sky 04 - December - 2012, at 11:28 AM

  • I was suppose to have 2 teeth (#19 &21)after the procedure was completed there were no stitches and I know there were no incisions made at any time. Did I just get charged for a service that was not used?

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