When your mouth lacks the space necessary to properly fit each tooth nature has provided, your dentist may suggest the tooth be removed to prevent overcrowding or damage to your other teeth. This is particularly the case with wisdom teeth that do not fully erupt through the gumline, and instead remain trapped (or, impacted) below the soft tissue of the gums.
In this dental procedure code, the tooth in question has broken through the roof of the alveolar bone encasing it in the jaw, but has not erupted through the gumline. When this occurs, the tooth is referred to as being a “soft-tissue” impaction. Impacted teeth are troublesome because they often come in horizontally, causing the tooth to grow at an angle interfering with adjacent teeth. They can also cause infection. It is for these two reasons impacted teeth are routinely removed.
There are two main types of tooth extraction, “simple,” and surgical. With a simple extraction, the tooth is removed using the same basic tools as with a surgical extraction, but without the need for any type of incision to the gingiva, nor segmenting of the tooth to aid in its removal. In contrast, a surgical extraction would require at least one of these two methods of enhanced extraction. This dental procedure code covers surgical extraction, and can also be referred to as an “open” extraction.
From a procedural standpoint, a surgical extraction of an impacted tooth is a straightforward event. Your dentist will provide local anesthetic to numb the area surrounding the tooth, or if you are overly anxious about the procedure, analgesia may be administered. Then, your dentist will make an incision along your gumline, creating what is known as a “surgical flap.” This “flap” of tissue allows a dentist to gain access to tooth hiding below the gumline.
Once the flap is created, (and only if necessary), your dentist will use a surgical hand-piece to gently layer away any portion of the bone encasing the tooth. This may be required if only a small portion of the crown has erupted from the bone, and greater access to more surface area is needed for efficient removal. If removal of the bone is necessary, once enough has been removed and the crown of the tooth is fully exposed, your dentist may need to segment (or, cut) the tooth in order to remove it. Exactly how a tooth is segmented is based on numerous factors including the number of canals present, and shape of the tooth's root. Additionally, any other nearby obstacles such as adjacent teeth or nerve bundles need to be considered.
Once segmented, your dentist will likely need to “rock” the tooth back and forth to ease in its removal. This is done either with a pair of forceps, or a dental tool known as an “elevator,” which is akin to a common lever, and somewhat resembles a small flat-head screwdriver. Since the bone in our jaws is soft, this gentle rocking motion actually compresses the bone slightly so the tooth can be removed without the need to apply excessive force. Final removal is usually done with a tug of the forceps.
Once the tooth has been removed, and depending on your next steps for care, your dentist may conduct a tooth socket graft to prevent bone resorption that begins rather immediately after the loss of a tooth, or simply allow the opening in the gum to heal on its own as with wisdom tooth extraction.