Complicative Surgical Tooth Extraction

Simple Extractions vs. Surgical Extractions

The surgical extraction of teeth is actually the most common surgical procedure provided in the United States, according to Doctors Ueckert and Bradley. When a tooth is visible above the gum line and your dentist can easily remove it with forceps, the procedure is called a simple extraction. If a more volatile tooth has yet to grow in, however, your dentist needs to remove gum tissue or bone in order to extract it. This is called a surgical extraction, and requires stitches to close the site so that it can heal properly. The doctor may also prescribe a more specific pain medication following the procedure.

Reasons for Surgical Extractions

By taking an x-ray and examining your tooth, your dentist can usually determine whether or not your extraction will be simple or surgical. But there are times when a simple extraction turns into a surgical. If a tooth breaks off during the procedure, for instance, it may need to be taken out in pieces.

Wisdom teeth often face surgical extraction because they're usually impacted, meaning they are not completely erupted into the mouth. This condition requires cutting through bone and tissue. Removing severely broken down teeth, root tips or teeth with long-curved roots are other examples of surgical extractions. Then there are times when the bone around a tooth has become dense, resulting in the need for surgical treatment.

Surgical Extraction

Surgical extraction (also called "open extraction") is a tooth removal procedure in which surgical access is required to completely remove a tooth. Even if the tooth is visible in the mouth without surgically exposing it, surgical techniques may be necessary to remove the tooth. This includes sectioning the tooth into two or more pieces, whether or not a soft tissue incision is made. Surgical extraction does not necessarily mean that the dentist removing the tooth has advanced training in oral surgery, and you will generally not be billed for a surgical extraction unless the tooth is sectioned into pieces, or an incision into soft tissue is made. Surgical extraction includes removal of impacted wisdom teeth (third molars), but this does not mean that all wisdom teeth requiring removal are required to be removed surgically.

Removal (extraction) of a tooth is prescribed if the tooth is too extensively damaged from decay (Figure 1) or trauma to be fixable, or if it is infected and the patient is not a candidate for endodontic (root canal) treatment. It is also frequently prescribed when the teeth of one or both dental arches are severely crowded, and straightening the teeth would require unnecessarily complex orthodontics with a potentially compromised treatment outcome.

Most commonly, either two or four bicuspid teeth are removed in such cases, and generally they are removed by "simple", not surgical technique. Sometimes the decision to remove a tooth is based on cost, if the procedures required to restore it would involve significant expense. This is especially true if the prognosis for the tooth (i.e. likelihood of long-term success) is not good. Wisdom tooth removal is frequently recommended, and ideally prescribed in the late teens to early twenties, if it is apparent that these teeth will not fit in the jaws in a normal bite relationship with normal gum tissue contours.

Extensively damaged teeth, and teeth with multiple curved roots frequently require extraction by surgical technique when removal is necessary. Teeth which have been endodontically treated and later need to be removed for some reason, frequently require surgical technique as their roots tend to be more brittle.