Tooth extraction - stages, indications, methods and recommendations

What is the tooth extraction procedure?

Removal or extraction is a dental surgical operation during which a tooth is removed from the alveolus of the jaw in whole or in part. In the first case, the crown and root part are removed, in the second, resection or hemisection is performed while preserving the dental unit.

Complete removal - removal of the crown and roots after separation of the soft tissues and rupture of the ligaments. It is indicated in cases of loosening, significant tooth decay, jaw fractures, or the need for orthodontic (for example, braces) or orthopedic treatment.
Resection is the excision of the apex of the affected root; it is performed when a granuloma or cyst is detected on it. Access is carried out microsurgically through the soft tissue and jaw bone in the projection of the inflamed area or neoplasm.
Hemisection is the amputation of one of the roots of multi-rooted (chewing) teeth along with the adjacent part of the crown. It is used for inflammatory processes, the impossibility of tooth-preserving treatment, pathological features or root fractures.

Complete tooth extraction

What is an impacted tooth?

Retention is an abnormality in tooth eruption, in which the tooth erupts partially or remains completely in the tissues of the jaw.
An impacted tooth is a tooth that has failed to erupt and “sleeps” in the gum or even in the jaw bone. There are cases when only part of the tooth crown erupts and is visible, and the rest of the tooth is covered by the gum - such teeth are called semi-impacted.

Most often, impacted canines and wisdom teeth are found - the notorious eights, but there are cases of impaction of the central and lateral incisors, and the first - a little more often.

When does a tooth need to be removed?

Removing a wisdom tooth or any other tooth is a last resort measure, used only when it is not possible or advisable to preserve the dental unit. In this case, extraction can be carried out either urgently, on the day of treatment, or delayed - according to an individual schedule.

Indications for emergency removal

It is urgent to remove a tooth in the following cases:

extensive carious lesions, impossibility or inappropriateness of caries treatment;
inflammatory diseases of periodontal tissues, odontogenic sinusitis;
pathological processes accompanied by acute pain, fraught with serious complications;
injuries to the teeth and jaw (fractures).

Indications for the planned procedure

Removal is delayed if:

teeth become loose due to weakening of the ligaments and periodontitis;
there are supernumerary, impacted (unerupted) or dystopic (severely displaced) dental units;
orthodontic treatment was prescribed to correct the bite (braces);
the tooth interferes with prosthetics, including implantation;
The baby tooth prevents the eruption of the molar tooth.

Indications and contraindications

Indications include the following:

genetic features of development;
early process of changing milk units;
the course of vitamin deficiency;
unnatural jaw development;
the presence of somatic weakness;
carrying out prosthetics or removal of problem units without following the established schedule.

The procedure is not carried out if there is no free space to move the element of the jaw row, there are no neighbors near the damaged unit, or when the intracanal pin is difficult to install.

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Contraindications

Even if a wisdom tooth (or another) hurts, removal may be contraindicated. Contraindications are divided into absolute (complete prohibition) and relative, when the operation can be performed under certain conditions. The first include blood diseases accompanied by reduced blood clotting (hemophilia, for example), oncological processes in the jaw area, as well as a recent history of a heart attack or stroke.

Relative contraindications include any acute conditions and pathological processes in the body (extraction is allowed after the exacerbation has stopped). The list includes:

renal failure;
cardiovascular pathologies (hypertension, arrhythmia, angina pectoris);
infectious inflammation of any localization;
stomatitis;
blood diseases (agranulocytosis, leukemia);
radiation sickness;
circulatory disorders;
cancer at the stage of therapy.

There are additional restrictions for women. Thus, it is not recommended to remove teeth during menstruation (due to decreased blood clotting), as well as in the first and last trimesters of pregnancy.

Features of the technique

The traction procedure allows you to correct the position of the tooth in the vertical or horizontal plane, restoring the natural anatomical position. This is due to the specific structure of the root area, as well as the effect of the targeted application of force. Dentists performing the operation create pressure zones, due to which histological changes occur in the structure of the jaw apparatus.

It is important to note that traction is not a one-step procedure and is carried out in several sessions. The duration of restoration of the natural anatomical position reaches several months, but in rare cases it can be significantly reduced. A factor influencing the rate of correction is the patient’s age.

The essence and types of tooth extraction surgery

Both emergency and planned removal of a wisdom tooth (as well as any other) is performed after diagnosis. In order to determine the shape and location of the roots and identify neoplasms, an x-ray is prescribed. The information obtained allows the doctors of the Yulistom clinic to perform an operation of any complexity as efficiently and painlessly as possible, and also completely eliminate the risk of complications.

Pain relief before surgery

The extraction can be simple or complex, based on which the dentist chooses the appropriate type of anesthesia. In the first case, complex manipulations are not required, so local anesthesia is performed using the application or infiltration method. In the second, two options are possible: local conduction or intraosseous anesthesia with potent drugs; general anesthesia is also possible. The latter is contraindicated if the patient is diagnosed with:

exacerbation of respiratory system diseases;
acute renal failure;
diabetes;
stage of decompensation of pathologies of the cardiovascular system;
hemophilia;
colds.

General anesthesia is also not done on a full stomach. Indications for this type of anesthesia when removing wisdom teeth are an uncontrollable fear of pain, as well as an allergy to topical medications and a strong gag reflex.

Simple tooth extraction

This term refers to extraction that does not require the use of complex instruments or additional manipulations. This method removes teeth with one straight root, a strong crown, as well as dental units that are mobile due to weakening of the ligamentous apparatus.

Dentists distinguish four degrees of mobility, determined by its intensity and direction:

The first is that the tooth can be rocked back and forth when the forceps are applied.
The second is that the medial-distal direction (in different directions) is added to the vestibulo-oral direction of movement.
Third, the crown and root part additionally move freely up and down.
Fourth, the tooth not only sways, but also partially rotates around its own axis.

Indications for extraction are grades 3 and 4. In such a situation, chewing food becomes difficult, and moving roots can injure soft tissues and provoke an inflammatory process.

Simple removal is performed after pain relief according to the following algorithm:

peeling of the gum from the neck of the tooth is carried out - ligamentomy;
the forceps are applied and securely fixed;
the dental unit is dislocated by the method of luxation (swinging) or rotation (rotation around an axis);
the tooth is removed from the alveolus;
the hole is inspected and treated with an antiseptic;
a gauze pad is applied.

The procedure, excluding the time required for pain relief, takes no more than 5 minutes.

Complex tooth extraction

It is carried out when the dental roots are curved or there are several of them, the crown is destroyed, completely or partially hidden under the mucosa. The technique is also used to remove lower and upper wisdom teeth, atypically located units, in the presence of cysts.

The operation is performed according to the same algorithm, but additional manipulations may be required. These include cutting the gums, bone tissue, sawing the tooth, and suturing the wound. For example, extraction of a tooth with crooked roots is done in the following order:

anesthesia;
sawing the crown with roots into several parts;
extracting fragments;
inspection, antiseptic treatment of the hole;
suturing.

Complex tooth extraction

The duration of the operation depends on the extent of the surgical intervention, so it can range from a few minutes to 2-3 hours or longer.

Basics of conducting

To carry out the procedure in question, diagnostics and preparation are required, after which the problem tooth is pulled out.

Once the process is completed, the patient will have to wait for some time, periodically checking with a dentist.

Identification of the defect location

The main objective of the presented procedure is to bring the defect site to an optimal position, located above the alveolar gum or ridge. This way you can restore the damaged element while maintaining the normal state of the periodontium.

It takes two to three visits to move a unit. First, the doctor carefully dissects the periodontal fibers and restores the normal position of the root. Next, the periodontal fibers take root in the resulting position.

Diagnostics

The essence of the diagnosis comes down to taking an x-ray, after which you can understand whether retention is present, at what angle the impacted element is cut, and in what sector of eruption it is located at the time of inspection.

Computed tomography allows you to most accurately determine the location and further possibility of carrying out the procedure.

It should also be noted that if the diagnostic results reveal the presence of an impacted canine tooth resting on the root of neighboring units, the patient will have to prepare for the loss of all of them.

The reason for this is the possibility of eating the roots of neighboring units that are located at an unnatural angle.

Preparation

The specialist inserts a pin into the inner part of the root, the end of which is equipped with a hook. Next, you need to install a wire “crossbar” on the adjacent teeth.

Using a special elastic band, the root is “suspended” to the resulting crossbar. Thanks to the traction that appears, the tooth is pulled out from the inner space of the gum.

Sometimes patients are embarrassed by the results of the preparation. To hide all defects during the recovery period, specialists create a composite veneer, which covers the treated area.

Carrying out

The procedure for carrying out such an operation includes two stages. At the first stage, a corresponding place is created in the jaw row, and at the second stage, the impacted element is brought into the desired position.

In most cases, the operation is performed with mandatory exposure of the crown.

The technique includes four main stages:

The crown of the problematic element is completely exposed.
A lock is installed on adjacent units, including the defective one.
Using elastic traction, the impacted canine is pulled out.
The canine is further extended using an elastic arch.

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Traction of an impacted tooth

Diagnostics

Again, the diagnostic procedure is carried out using computed tomography. It allows you to check at what angle the defective area is located and what the next steps will be for comprehensive treatment.

On average, diagnosis takes from 5 to 10 minutes, depending on what kind of computed tomography is performed.

Preparation

Before the procedure is carried out, it is necessary to completely cure all teeth. The technique is also applicable to molars, but in this case the possibility of furcation exposure cannot be excluded. This, in turn, can reduce the lifespan of the restored unit.

Immediately before the operation, the specialist must administer local anesthesia. Surgeries are possible only if the patient’s condition allows them to begin work (the area of the oral cavity being treated is fully prepared for surgery).

Carrying out

The essence of the technique is as follows:

Using orthodontic forceps.
Installation of a pin with a special loop before cementing it in a specially designated channel.
Installation of a bracket that is completely adapted to the hard tissues located in the adjacent space.
Cementing the pin in the canal with subsequent fixation of the bracket to the elements of the jaw row located nearby.
Installation of elastic fiber.
Installation of a fixed elastic cord followed by fibrotomy.
Relocation of the problematic root, seven days later.

Complications

Both before and after the operation, the doctor must familiarize the patient with how to behave correctly for the fastest and highest quality recovery.

When moving, the tooth has to move for a long time, turning in parallel by a certain number of degrees.

If all instructions are followed correctly, the process will not take long. On the other hand, neglecting the rules and forcing events leads to potential complications, for example, bone tissue will begin to resorb, which will negatively affect the roots.

It is possible that in the future it will be necessary to completely remove both the problematic element and the neighboring ones, since they are in close contact with the deformed area with their base.

The video presents one of the orthodontic tooth traction techniques.

Features of extraction of different types of teeth

Milk and permanent teeth are removed in different ways. The methods for extracting one or more dental units located on the upper or lower jaw also differ. The removal of wisdom teeth has its own characteristics due to pain, improper eruption, and atypical location.

Removal of baby teeth

Baby teeth can be removed at any age if it is not possible to save them. The manipulation is usually performed under local application anesthesia (painkillers are applied to the gums) or an injection is given. In cases where the child is not contactable due to age - up to one and a half years - or for other reasons, general anesthesia is given.

Indications for simple removal are:

extensive carious lesions;
inflammatory processes – periodontitis, pulpitis;
the baby tooth prevents the eruption of the permanent one or does not fall out after it;
pronounced dystopia.

The features are due to the fragility of the enamel and the weak expression of the neck. For extraction, a special tool with a loose grip is used; the extraction itself is performed in one movement.

Removal of upper teeth

Incisors and canines with one root are removed in a simple way, and multi-rooted molars and premolars are removed in a complex way. Removal of upper dental units has a number of the following features:

teeth are removed from the alveoli more easily, since the structure of the jaw bone tissue is more porous;
the roots are usually straight, which also makes manipulation easier;
anesthesia acts faster and stronger;
due to less trauma, healing after removal of a wisdom tooth (or another) is faster.

During the operation, the patient's head should be tilted back. This gives the doctor a full overview and access to the desired tooth.

Removal of lower teeth

By analogy with the upper ones, simple removal is used for single-rooted teeth of the lower jaw, and complex removal is used for chewing teeth. Due to anatomical features during the procedure, the doctor may encounter the following difficulties:

often there are dental units with curved roots;
increased bone density, making surgery difficult:
low effectiveness of anesthesia (does not work for a long time, insufficient pain relief).

The patient's head should be tilted forward during removal. When removing front teeth, a straight head position is possible.

Wisdom tooth removal

This is the name given to third molars, which usually erupt in humans between the ages of 15 and 25. They are considered a rudimentary formation, therefore they often grow with displacement, quickly collapse, injure the mucous membrane, have a non-physiological crown shape, and curved roots. These teeth may remain impacted (unerupted); in case of incomplete eruption, they form a fold in the gum (“hood”), which often becomes inflamed.

Removal of a wisdom tooth with a “hood”

The listed features of wisdom teeth are a recommendation for removal. Their extraction is a complex operation for the following reasons:

difficult access due to location;
the need to cut the gums due to retention or destruction of the crown;
the need for longitudinal sawing of the tooth for its gradual extraction due to curved roots.

After wisdom teeth are removed, stitches are often needed. Also, sometimes a bandage soaked in medicine is placed in the hole; it must be changed regularly when visiting a doctor.

Removal of several teeth

Simultaneous extraction of a significant amount or all dental units is carried out according to indications - before prosthetics, for periodontal disease. The order of complex and simple extraction during the operation is determined by the dental surgeon individually for each patient. The exact number of teeth that can be removed in one visit also varies individually and is determined by a combination of several factors:

type of anesthesia - under general anesthesia, a larger volume of surgical intervention is permissible, and local drugs have restrictions on the duration of action and dosage;
client comfort - gradual removal is possible (first on one side, then on the other, after healing, which makes it easier to eat) or simultaneously, if it is more convenient for the patient;
difficulty of removal - when it is necessary to saw a lot of teeth, cut a significant area of the gum surface, extraction is performed in several stages;
general health, absence of specific contraindications (reduced blood clotting, vascular and heart diseases, hypertension) - after the removal of a wisdom tooth and others, an extensive wound surface is formed, which is fraught with bleeding and infectious inflammation.

Expected effect

The tooth is pulled out using a specially installed system. Although the procedure occurs without any pain, you should prepare in advance for the fact that you will have to spend a lot of time.

As practice shows, it takes an average of 3-4 months to restore milk units, while for older patients it can last up to nine months.

When determining the amount of time required for treatment, the complexity of the individual case and the current condition of the oral cavity as a whole are taken into account. With the help of a chain, the doctor completely extends the element with every millimeter.

The end result is complete extension of the tooth. The best option is when a third party is shown the results of treatment without telling him about the fact of the procedure, and at the same time he does not understand what the differences are between a normal and an extraordinary situation.

In other words, the result is of high quality only when the tooth is fully extended to return to its normal physiological position.

The operating time of the elongated element may also vary depending on the condition it was in at the time of treatment.

It is extremely important to prevent the development of any diseases, as well as to cope with existing pathologies. Otherwise, the patient risks encountering complications in the form of infection in the treated area and nearby units.

In terms of time of use, the treated molar will be no different from the rest. The main thing is to adhere to the rules of personal hygiene and constantly monitor the appearance of signs of the disease.

But this will be prevented by regular visits to the dentist. One way or another, you will still have to regularly go to the dental office, because doctors need to fully control the recovery process.

Recommendations after tooth extraction

Immediately after the wisdom tooth is removed, the hole is treated with an antiseptic and a gauze swab is placed in it. It is necessary to stop bleeding and form a protective blood clot. You need to remove the tampon after 20-30 minutes.

What to do to prevent tooth pain after extraction

Eating is allowed no earlier than two hours after surgery, and chewing should be done carefully so that food particles do not damage the blood clot. You can drink drinks at a neutral temperature earlier, immediately after removing the gauze swab.

During the healing period of the postoperative wound, which lasts from 3 to 5 days, it is recommended to eat only pureed warm food. Rough foods, too hot or cold foods should be avoided. You need to chew on the side of the jaw that has not been operated on, so as not to destroy the blood clot.

After the wisdom tooth is removed and the anesthesia wears off, pain may occur. To relieve pain, it is recommended to take Ibuprofen, Ketorol, Nimesil. To prevent bacterial infection, antibiotics are prescribed, especially for periodontitis or after the extraction of a significant number of teeth. To avoid swelling, you can apply cold in the first hours.

It is not recommended to rinse your mouth in the first few days after surgery, so as not to damage the blood clot in the socket. Oral baths using Chlorhexidine and Miramistin are acceptable. You can brush your teeth after 24 hours, using a brush with soft bristles and not touching the operated area of the gum.

It is strictly forbidden to eat or smoke in the first 2 hours after the removal of a wisdom tooth or any other tooth. Over the next 3-5 days you cannot:

eat food and drinks of contrasting temperatures;
drinking alcohol;
eat viscous, hard foods;
touch the hole with your tongue;
allow increased physical activity.

Contrary to popular belief, you should also not drink liquids through a straw during this period. This method of drinking drinks promotes the formation of a vacuum in the oral cavity, which leads to the destruction of the blood clot.

Removal steps

The entire tooth extraction procedure is divided into several successive stages. First of all, the doctor must inject an anesthetic into the place where the removal will take place. This is followed by mandatory sanitation and antibacterial treatment of the oral cavity. The specialist can then begin to remove a small area of gum tissue to gain access to more of the tooth. Using forceps, the tooth is gradually rocked and extracted.

It is almost impossible to determine in advance how long the operation will take. Anesthetics begin to act approximately 15-20 minutes after injection into the gum cavity. On average, removal takes no more than 1 hour in complex cases. The operation may be delayed due to sudden complications, for example, tooth crumbling, inability to remove the entire tooth with its roots in one grip, etc.

The position of the doctor during the operation largely depends on the location of the tooth requiring removal. After the desired tooth has been extracted, it is necessary to carry out hemostatic procedures to restore the integrity of the gums. Most often, if the wound is large, stitches are placed on it. There should not be severe bleeding; it completely disappears within 10-20 minutes after all the manipulations.

How to take care of your teeth

How does socket healing proceed after tooth extraction?

The healing process goes like this:

After a wisdom tooth is removed, a socket filled with blood is formed. Within 2 hours, the blood clots and a blood clot is formed, which is necessary to protect the wound from infection. The postoperative socket at this time has a dark red color.
In the first 2-3 days, the blood clot decreases in size, darkens and thickens. The process of formation of granulation tissue begins, which is necessary for the restoration of the gum mucosa.
Within three days to a week, the clot lightens and becomes whitish. Young connective tissue fills the hole almost entirely. At the same time, pain and swelling completely disappear.
On days 7-10, the thrombus resolves, and the hole with light granulation tissue decreases in size. The process of bone tissue formation begins, which completely fills the defect within six months.
After 15 days, superficial healing is complete, the gums are covered with a pink mucous membrane.

Thus, the postoperative wound usually heals within 2 weeks. Recovery from a complex wisdom tooth extraction may take longer as the tissue is usually more damaged. The healing time is also influenced by the condition of the oral cavity, the presence of infectious diseases, individual characteristics of the body, and correct adherence to medical recommendations.

Stages of healing

Norm and pathology

Immediately after extraction, the patient does not feel anything, as the effect of the anesthetic continues. As the effect of the drug wears off, pain of moderate intensity appears. Normally, they completely disappear no later than three days.

After wisdom tooth removal, swelling of the gums is possible, especially if the soft tissues were significantly injured during the operation. Within three days, the swelling goes away without causing much discomfort.

The blood stops within half an hour, a blood clot forms, completely covering the hole, so there should be no bleeding during normal healing. However, if you touch a clot, slight bleeding may occur.

The listed phenomena are natural for the postoperative period and should not cause concern. Reasons for urgently contacting a doctor are:

Intense pain that increases over time. If the gums hurt very much after wisdom tooth removal for more than three days, and analgesics do not help, an inflammatory process is likely.
Persistent swelling of the gums and the development of swelling of the face on the operated side are also symptoms of inflammation.
Bleeding that lasts several hours or re-opens after stopping indicates vascular damage.
Elevated body temperature is a sign of infectious inflammation, which is fraught with serious complications.
A deep empty hole covered with a yellow-gray coating with a bad odor indicates alveolitis, an inflammatory complication.
Purulent discharge from a wound, especially in combination with pain and swelling, is a sign of tissue infection.
Runny nose and nasal discharge are the result of perforation of the maxillary sinuses during surgery.
Paresthesia - numbness of the cheeks, tongue, lips, after the anesthesia has worn off, indicates nerve damage.

Indications for tooth root removal

Complete destruction of the coronal (supra-gingival) part, affecting the root system;
extensive purulent-inflammatory process at the root: cyst, abscess;
longitudinal axial fracture;
previous incorrect extraction - during removal, fragments remained in the hole, causing an inflammatory process that affected nearby tissues.

The damaged area of the tooth is easily identified visually. Additional symptoms of the need for urgent medical intervention and even possible removal of a diseased tooth are:

twitching, throbbing pain;
acute pain due to mechanical action - pressing, biting, chewing food;
unpleasant odor;
gum hyperemia;
a purulent process is a direct indication of the need to remove the root of a diseased tooth;
elevated body temperature.

If one or more symptoms are present, the destroyed units are removed. In some cases, incomplete removal is performed - resection of the tooth roots. This usually occurs when the root apex is affected by periodontitis, a small cyst, or granuloma. Often in such diseases the coronal part is preserved. In this case, the damaged part is removed through an incision in the gum. Subsequently, installing a crown solves the problem of restoring the chewing unit.

How to avoid complications

Inflammatory processes in the postoperative period usually occur due to the fault of patients who do not follow several basic rules. The dentist will tell you what to do after removing a wisdom tooth or any other dental unit to prevent negative consequences. Standard recommendations are as follows:

Do not touch the blood clot in the first three days so as not to damage it. This clot naturally reliably prevents infection from entering the wound.
Follow the advice on nutrition and oral care - eat only approved foods, brush your teeth carefully.
Take antibiotics prescribed by your doctor, especially in case of periodontal disease or after removing a significant number of teeth.

Complications can also arise due to the fault of the dentist. In addition to infection of the wound with unsterile instruments, there is a risk of jaw fracture, damage to nearby teeth, and incomplete removal. Such situations can be avoided; you just need to choose a clinic with an impeccable reputation. Yulisty employs highly qualified dental surgeons, so the possibility of medical error is completely excluded.

Effect of milk tooth removal

Serious reasons for removing (extracting) teeth in children are often discovered during a routine examination. The effect after the procedure depends on the degree and nature of the violations. Extraction of a tooth severely damaged by caries will protect the child from the inflammatory process and possible complications. Removing baby teeth that interfere with the eruption of permanent teeth will contribute to the formation of a correct bite and normal jaw development.

When you have to part with your teeth

Despite the fact that dentists try to preserve the patient’s own dentition for as long as possible, many people still have to undergo tooth extraction for one medical reason or another. This procedure is a full-fledged surgical operation and should only be performed in a dental clinic by a dental surgeon - attempts to perform it yourself can lead to serious negative consequences for the patient.