Removal of the teeth (including the removal of the wisdom tooth removal of the wisdom tooth) is the most common surgery in the practice of a dental surgeon. The decision on the relevance to remove a tooth (including the removal of the tooth root) is taken by the dentist on the basis of clear indications and contraindications for removal.
Indications for the removal of teeth
We consider the most common indications for the removal of teeth, which can be divided into several groups:
- longitudinal fracture of the tooth/root;
- fracture of the crown without the possibility of further recovery;
Medical prescription or therapeutic indications, because of the impossibility of performing conservative dental treatment due to:
- significant destruction of the crown of the tooth without the possibility to use its crown or roots for prosthetics;
- obturation of the root canal with a broken endodontic tool (poor treatment of the tooth canal) when it is impossible to remove it;
- features of anatomical nature (obstruction, or curvature of the root canals);
- errors in dental treatment, which caused perforation of the root or cavity of the tooth (if these damages cannot be eliminated).
Orthodontic indications among which:
- Displaced teeth or teeth occupying an incorrect position in the dentition, displacing adjacent teeth that injure the mucous membrane, and are not subject to orthodontic treatment;
- Impacted or non carved teeth, traumatizing the mucous membrane. They are completely or partially covered with bone or gum tissue, and can be located in the full-thickness of a bone or can be covered only by the mucosa. More often the impacted teeth are the wisdom teeth. Today, removal of the impacted teeth – is one of the most frequently performed surgical operations in dentistry.
Impacted teeth, which, not only injure the buccal mucosa but also adjacent (seventh) teeth.
Supplementary teeth (hyperdontia) – increased number of teeth – on orthodontic and cosmetic indications;
Impacted and displaced teeth causing the cysts growth and inflammation in surrounding tissues, if these phenomena cannot be eliminated in another way;
Removal of displaced wisdom teeth, causing pathological processes in the surrounding tissues (difficult cut of the teeth).
Periodontal indications, such as considerable tooth mobility, an extension of the tooth from the alveolus with simultaneous exposure of the roots, especially when such a tooth interferes with chewing, traumatizes the surrounding soft tissues or prevents prosthetics.
Removal of a tooth implant
A few words about the removal of a tooth implant. Fortunately, in the daily practice of most dentists, this procedure is very rare and doctors resort to it only in extreme cases.
Everyone knows that a dental implant is absolutely not susceptible to caries or corrosion since it is made from commercially pure titanium. Nevertheless, there are conditions under which it is not possible to keep a dental implant, and it must be removed. There might be the following conditions:
- mechanical damage – fracture of the implant itself or one of the components of the structure, when the lesions are so serious that there is no possibility of further exploitation of the dental implant;
- mobility of the dental implant due to complete disintegration, inflammation, trauma, etc.;
- obsolete types of dental implants can be removed for orthopedic and aesthetic indications.
If the installation of the dental implant is done by a trained specialist, in compliance of all the implantation stages and using high-quality material (i.e, the implantologist’s work is performed at a high professional level), and all the rules of hygiene and care for the dental implant are observed, then with a high probability these unpleasant consequences can be avoided.
This is only a small part of all indications for the removal of the tooth. In any case, the dentist takes the decision to remove the tooth depending on each individual clinical case.
In most cases, the removal of the teeth (including the removal of the wisdom tooth, removal of the molar) is performed by the dentist under local anesthesia which makes it possible to remove the tooth without pain, but reserve tactile sensations (sense of touch, pressure, instruments’ vibration, etc.) for the patient. In case of excessive fear, anticipated difficult removal and prolonged surgery, inability to keep the mouth open, if the patient is a toddler, or simply if the patient is reluctant to feel all the effects of the surgery, then it is possible to remove the teeth under general anesthesia or in a state of medical sleep.
How long does it take to remove the tooth?
«How long does it take to remove the tooth?» – a question that is asked by all patients who are off to remove the tooth. On average, the usual uncomplicated tooth removal takes between 20 and 45 minutes. Depending on the specific clinical case, these figures may vary. Sometimes it takes more time.
Immediately after tooth removal, the postoperative period begins, during which the body begins to repair damaged tissues and directs protective functions to the area of surgery. In this regard, in a few hours after the surgery may appear:
- soreness in the area of surgery and adjacent soft tissues,
- slight bleeding from the alveolar socket of the tooth, temperature increase. All these symptoms are normal after dental surgery, and each patient has his / her own degree of vulnerability, depending on the duration, complexity of the surgery and individual characteristics of the body.
On average, all of the above unpleasant things last from 3 to 7 days, but in some cases, sensation of pain can be present for up to 2 weeks, depending on the peculiarities of the dental surgery performed and the response of the body.
If the healing passes without any peculiarities, then as early as 2 weeks after tooth removal, a new granulation (vascular) tissue appears in the alveolar socket. At the end of 4 weeks after tooth removal, the granulation tissue is replaced with an osteoid (a new bone tissue, which will eventually become mineralized, turning into a trabecular bone tissue). An alveolar socket is externally epithelialized (covers), and, in fact, there are no marks of the removal. After the expiration of this period, it is possible to start the recovery of the lost tooth (if necessary) by one of the orthopedic methods of treatment – prosthetics of the teeth.
Wisdom tooth removal
Particular attention should be given to the removal of third molars or the so-called “wisdom teeth“. Unfortunately, most people are experiencing certain problems related to these teeth to one degree or another. Why does this happen? Let’s try to see into the matter. Due to the change in diet (reduction in the consumption of solid and firm food), the size of the dentoalveolar system of most people is gradually decreasing. In connection with the fact that the eighth teeth (or wisdom teeth) are embedded, formed and cut through in the last turn, then, as a rule, there is no adequate place in the dentition for them. As a result, the following situations may occur:
- dystopia – incorrect position of wisdom tooth;
- impaction or semi-impaction – complete absence or partial cut of the wisdom tooth due to the presence of a mechanical obstacle. In the future such situations can lead to a number of complications, namely:
- purulent inflammation in the formed periodontal pocket (occlusal pad) between the gum and the wisdom tooth – pericoronitis;
- caries of the 8th (wisdom tooth) or the adjacent tooth due to the impossibility of adequate hygiene of this area;
- chronic trauma of the mucous membrane of the cheek in connection with the wrong (the so-called “buccal” position of the third molar);
- o disruption of the frontal group of teeth due to excessive pressure from the side of the impacted tooth.
Due to the fact that such teeth have an incorrect position, the specificity of removal, the duration of the surgery to remove them and the postoperative period may differ from the conventional removal.
So what is the difference between the traditional and complicated removal of teeth?
Imagine a clinical situation when the wisdom tooth has not yet cut through, is deep in the full-thickness of the bone and partially “rests” on the adjacent tooth. In this case, the technique of atypical removal is used. That is, except for the removal of the wisdom tooth, the surgeon should additionally make a cut of the oral mucosa in the area of surgery in order to create access to that tooth. Then, if necessary, remove the bone tissue covering the crown of the tooth, divide the tooth into several parts (sectioned) using drills, and remove each tooth fragment separately. After removal, the alveolar socket is revised, curettage (removal of all inflamed and non-viable tissues) is performed, and a drug is left in the alveolar socket, which helps to heal it and prevents inflammation and bleeding. The alveolar socket is occluded to speed up the process of epithelialization. It sounds scary, but in fact, the sensations are not much different from the usual removal, except for increasing the duration of the removal manipulation itself.
In addition to wisdom teeth, atypical (difficult) removal is often resorted to when removing other teeth, since such removal is more predictable, less traumatic and creates favorable conditions for healing the alveolar socket and retaining bone tissue. And the latter for the dentist is always worth its weight in gold since it is very important for further planning of implantation in this area!