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 specifically refers to the removal of an erupted (or, visible) tooth. A surgical extraction can also be referred to as an “open” extraction.
Determining the type of extraction depends on the sturdiness of the crown, as well as the curvature of the tooth root. Teeth that are broken above the gumline, or decayed to such a degree that forceps cannot be used, would require surgical extraction. Likewise, because of their complicated design, multiple, curvy roots, may sometimes require a surgical incision and quartering of the tooth despite a sturdy, healthy crown.
From a procedure standpoint, a surgical extraction is a fairly 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, if necessary, your dentist may 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 the tooth's root via the gingiva, and is common if the crown has eroded due to extreme decay.
Once the flap is created, your dentist will then probe around the base of the gumline with a tool called a periotome, and separate the tooth from the fibrous (ligament) tissue that joins it to the bone in your jaw, and acts as a shock absorber to chewing stressors. Once the tooth is severed from this ligament, should segmenting of the tooth be necessary, your dentist will divide it into more manageable parts by segmenting it with a dental drill. How many parts the tooth will be divided into is based on numerous factors including the number and shape of the tooth root as well as any other nearby obstacles such as adjacent teeth and nerves.
Once the tooth is segmented, your dentist will likely need to “rock” the tooth back and forth within its socket 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, unlike some of the other bones in our body, 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 proceed with the immediate placement of a dental implant, 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.