Complicated tooth extraction

A complicated tooth extraction is a surgical procedure to extract branched and problematic roots. The procedure involves using special instruments and may require dissecting the periosteum and the gum. It is performed in complicated clinical situations and for wisdom tooth extraction.

The difference between simple and complicated tooth extractions

A complicated tooth extraction procedure is prescribed by the doctor after a thorough examination and visualization of the anatomical features of the roots. In contrast to a simple permanent tooth extraction, it involves the following:

• It lasts long - from 30 to 60 minutes.
• A special set of instruments is used, as it is impossible to use forceps and an elevator to get access to the affected area.
• A local anaesthetic is necessary, and even a general anaesthetic may be used, because branched roots cannot be extracted without anaesthesia.
• Surgical wisdom tooth removal occurs by dissecting and lifting the gum to ensure a firm grip during extraction. If necessary, the roots are cut.
• Suturing.
• Sometimes strict monitoring is required after the procedure, so the patient needs to make a few scheduled visits to the clinic.
• The rehabilitation period may be quite long, e.g. after the extraction of impacted teeth.

To avoid infection, the doctor will prescribe antimicrobial drugs.

Indications for the surgery

A complex operation is needed in the following cases: :

• It is necessary to extract an impacted wisdom tooth.
• It is necessary to extract erupted teeth, but the gum has to be cut to get access.
• Roots are severely damaged, curved and growing in an abnormal direction.
• There are complications in the arch, such as abscesses and gum boils.

Do not ignore the problem and visit the dentist as soon as the first symptoms appear. In this case, the price of having a complicated wisdom tooth extracted will be lower.

Extraction procedure

Prior to the operation, x-rays will be taken to determine the depth, growth direction and number of roots. If there is an inflammatory process, antibacterial therapy will be necessary one day before the operation.

The stages of the procedure:

• Local or general anaesthesia.
• Dissecting soft tissue and lifting the gum from the neck of the tooth, using a syndesmotome.
• Cutting out a bone section and cutting the interradicular septum.
• Using appropriate instruments to grip and extract the root.
• Applying stitches.

The dentist decides on the best complicated extraction technique depending on the clinical picture:

• Using forceps is a sparing technique when the crown has retained its integrity and it is possible to grip it with an instrument and extract the roots completely;
• Using an elevator or luxator is necessary if the tooth is located outside the arch and it is impossible to extract with forceps. The instrument is inserted into the periodontal ligament space cutting the ligaments that hold the tooth in place and then pressing it out of the socket.
• Extraction with an air-turbine or boost handpiece is a technique used to extract roots having a few branches. They are separated and each branch is extracted one by one.

The particular technique to be used is selected by the dentist taking into account the depth and anatomical features of the roots and any inflammatory processes present.

Wisdom tooth removal

Due to anatomical features and a lot of branched roots, the most frequently used extraction method is by using an air-turbine or boost handpiece. It is necessary to cut and raise a tissue flap, which is afterwards sewn in by applying stitches.

Indications:

• A severely decayed crown;
• Teeth are misplaced or impacted;
• An abnormal root system;
• Inflammation causing a strong pain or gum swelling.

The stages of the procedure:

• Local or (if necessary) general anaesthesia, sedation.
• Elevating tissues from the bone.
• Drilling and cutting roots.
• Extracting the third molar.
• Applying an antiseptic to the socket.
• Applying non-absorbable suture material.
• Removing stitches after the wound edges have been healed.
• Taking antibiotics.
• Scheduling follow-up visits.

Wisdom teeth erupt later than others and often grow with a significant misalignment angled away from the other teeth. Pain caused by extraction is stronger with wisdom teeth than with others. After the operation, the gum can swell noticeably and the body temperature may rise.

Recovery

For a quick, complication-free recovery, dentists recommend following these rules:

• Do not rinse your mouth or clean your teeth for two days after the extraction.
• Do not disturb the wound with your tongue, finger or a sharp object.
• Do not eat during the first two hours.
• No exposure to cold or heat. It is not allowed to take a sauna or a hot bath.
• Avoid hard food, alcohol and smoking.
• Chew food on the opposite side of the jaw.
• Take all medication as prescribed: pain, antibiotics, antihistamines, anaesthetic ointments and gels.
• Do not suck liquid out of the socket.
• Do not take blood thinners.
• Do not eat hot food.

It is advised to apply trays with a weak 0.05% chlorhexidine solution at home. A cold pack worn on the cheek will help to relieve pain. After 2-3 days, it is possible to rinse the mouth with a saline solution, as it assists in speeding up wound healing. Using a manganese solution for the same procedure is also possible. Herb solutions, i.e. oak bark, camomile and calendula, have an antiseptic and astringent effect.

In order to avoid post-operative complications or a socket inflammation, and make a quick recovery, accurately follow the dentist’s advice.

Axioma Dental Clinic would like to invite patients to a complicated wisdom tooth extraction procedure in the lower and upper jaws without pain.