Types of Tooth Extraction
The reason for a tooth’s demise may be uncontrolled decay, failed previous therapy that cannot be salvaged, severe periodontal (gum) disease, or to provide for a better dental prosthesis (“prosthetic expediency”). When extractions are performed without surgical sectioning of the tooth, bone removal, and the need for tissue incision, they are called “simple extractions.” However, many of these extractions can be difficult with unanticipated complications. The clinician may make a plan change in the middle of the procedure and decide that the tooth must be removed surgically. Typical simple extractions do not require sutures and dressings, but it is also not uncommon for them to be used as a measure to prevent complications during healing.
While it is generally preferable to save teeth through modern disease control methods, gum disease therapy, root canal therapy, and restorative reconstruction of damaged tooth structure, there are time when teeth must be extracted for the best outcome.
VIDEO: Simple Extraction
VIDEO: Surgical Extractions
In cases where the anatomy of the tooth to be extracted does not permit adequate non-surgical access or will likely result in avoidable trauma to the surrounding tissues or teeth, surgical access may be necessary and appropriate. An incision is made either with a laser or with a scalpel, a control amount of bone surrounding the tooth is removed, and the tooth may be sectioned into two or more pieces for retrieval. Lasers usually result in less post-op discomfort, but the extraction surgery may take longer than the conventional surgical method with a scalpel and rotary handpiece. Many times, sutures and wound dressings may be used to control the tissues and apply pressure after surgical extractions, but they are not always necessary.
VIDEO: Consequences of Extracted Tooth
Once a tooth is extracted, the socket tends to collapse both from top to bottom and from outside to in, which may compromise the bone supporting the adjacent teeth, reduce the bone available for future implant replacement, increase risk of injury to the main nerve in the lower jaw or to the sinuses in the upper jaw by reduced bone thickness for protection, or create a situation where esthetics of a future bridge would be compromised. Therefore, it is becoming routine for dentists to recommend bone replacement grafts at the time of extraction to at least preserve the width of the socket. Often purified bone particles from a cow or even from another person are used for this purpose, but live bone from the same patient can often be used. Once the bone is placed, a membrane that either dissolves on its own or must be removed after the graft has healed may be used to protect the graft. While bone grafting significantly increases the cost of the extraction, most patients report that it is well worth the additional expense.