Tooth extraction technique: how it happens

• Main indications and contraindications
• Complex tooth extraction: features of the procedure
• Tools used
• Healing process after surgery
• Complex tooth extraction in Moscow: reviews of treatment at A-Medic

There are two main types of tooth extraction in dentistry - simple and complex.
The first is used when it is necessary to remove teeth with one root, and the second when the root has a complex structure and several branches. During complex surgical interventions, special instruments are used. Tooth extraction in Moscow is performed by the reliable dental clinic “A-Medic”. The company's employees have high professionalism and extensive experience, which allows surgical intervention with minimal risk of complications. The clinic is equipped with modernized equipment, thanks to which all stages of the procedure are controlled. The cost of a complex tooth extraction in the clinic is only 3,500 rubles.

Main indications and contraindications

Complex removal is required in a number of complex clinical cases when it is not possible to perform surgical intervention using standard techniques and instruments. Very often it is carried out in relation to the last painters (“eights”). As a rule, they do not have enough space, against which they begin to grow incorrectly (for example, erupt towards the cheek, injuring the mucous membrane), slowly erupt, accompanied by painful sensations. The last molars do not participate in the chewing process, so most often the dental surgeon decides to remove them in such situations.

Complex surgical procedures are resorted to in the presence of a chronic inflammatory process, against the background of which the bone tissue and the molar or premolar itself have fused. A complex operation cannot be avoided if the molar has several roots or its area is severely curved. Benign neoplasms (for example, granulomas or cysts) are often an indication for removal if the tooth is destroyed and there is no point in trying to restore it. Sometimes a complex extraction of a previously treated tooth is performed several times. This is due to the fact that it is not durable, its density is weakened, and it is capable of cracking.

As with any surgical intervention, there are a number of absolute and temporary contraindications to complex removal of molars or premolars. Among them:

• diseases of viral etiology;
• serious deviations from the cardiovascular system;
• pregnancy and lactation;
• blood diseases (anemia, poor clotting, leukemia);
• chronic pathologies during exacerbation;
• recent strokes and heart attacks;
• serious mental disorders (schizophrenia);
• long-term use of medications that affect blood clotting.

Elevator

When an impacted or unerupted tooth (most often wisdom teeth) needs to be removed, the dentist will use an elevator. The tool consists of a handle and a working part, which is used to extract the root. The elevator operates on the principle of a lever, that is, the doctor literally picks up the tooth from below and removes it from the bone tissue. Removing teeth using elevators is very traumatic, but in some situations you simply cannot do without them.

Elevator for tooth extraction

Complex tooth extraction: features of the procedure

Before performing a surgical intervention, the specialist prescribes the necessary diagnostic examination (instrumental and laboratory) to the patient. First, he is sent for an X-ray examination. Using this technique, it is possible to assess the general condition of the root system and clearly see the location of the tooth in the jaw. For a more detailed analysis, obtaining images of various dental structures layer by layer, computed tomography is prescribed. It makes it possible to detect in advance the factors complicating the surgical intervention, to establish the approximate time and complexity of the procedure.

Removal of a molar or premolar is always performed under the influence of an anesthetic. To avoid negative consequences, it is recommended to first visit an anesthesiologist to identify a possible allergic reaction to a particular substance. To determine contraindications (for example, exacerbation of a chronic disease), it is recommended to undergo laboratory diagnostics - a general blood test. In the absence of contraindications, they proceed to surgical intervention. The procedure and technique for implementing the removal technique are as follows:

1. Conducting anesthesia. Depending on the age, neglect of the clinical case and the general physical condition of the patient, local or general anesthesia with a potent drug may be used.
2. Incision of soft tissues and separation of gums.
3. Sawing out a small area of ​​bone tissue and the coronal part, sawing the septum (only if necessary).
4. Gently rocking the tooth using special tools and removing it completely.
5. Applying sutures to the gum area.

If the wisdom tooth is located next to the mandibular nerve, the procedure becomes a little more complicated. This is because its roots are able to surround the area of ​​the nerve. In such a situation, the roots are divided and removed with extreme caution so as not to touch the nerve. To carry out high-quality surgical intervention, a qualified dental surgeon is required.

Types of forceps

The instrument is used to extract teeth using the lever principle. Its main parts are: handle, lock and cheeks. With the help of the last section, the coronal part of the element to be removed from the oral cavity is fixed. The doctor holds the instrument by the handle and rotates it in the required direction. The lock is part of the connection between the cheeks and the handle. To remove different types of units, separate types of forceps are used, differing in design features and sizes.

Forceps for extracting units on the lower jaw

The following types of forceps are used in the process of removing lower teeth:

• Beak-shaped. Designed to remove units with intact coronal part. The cheeks in these instruments are located at an angle of 90 degrees to the handle. The cheeks can be either converging or non-converging.
• To remove wisdom teeth. They have curved cheeks that can penetrate hard-to-reach areas of the row.

Beak-shaped forceps for removing teeth on the lower jaw.

Forceps for removing teeth on the upper jaw

There are several types of tools for extracting the upper elements:

• Bayonet or universal. With their help, you can eliminate almost any affected unit of the upper jaw. Depending on the width of the cheeks, instruments are divided into narrow, medium and wide. The axes of the handles and cheeks of bayonet-shaped pliers are parallel to each other.
• Direct. Designed to eliminate milk units or elements located in the front. The working part of the tools and their handle are located on the same line.
• S-shaped. Necessary for extraction of chewing units of the upper jaw. The cheeks of the forceps do not touch each other. There are several types of the instrument in question: left-handed and right-handed. One part of the cheek has a rounded shape, the second ends with a spike.
• To remove top eights. The cheeks and handle of the tool are located on the same axis. Both cheeks are rounded at the ends, and their inner part has indentations. This design ensures convenient penetration of the forceps into the oral cavity. During extraction of the upper eights, there is no damage to the lower wisdom teeth.

Elevators

Main structural elements: working part, handle, connecting rod. Depending on the width of the working part, all tools are divided into wide, medium and narrow. The devices also differ in the principle of operation - from themselves and from themselves.

There is a groove on one side of the working part of the elevators, and a convex part on the other. And also instruments are divided into straight and convex. The first type of device is used to remove single-root elements or to separate the roots of multi-root units from above and below. Angled structures are used to remove teeth whose roots have not been preserved.

The tooth is removed using an elevator using the lever principle. During the operation, the surgeon holds the alveolar process with the thumb and index finger of his left hand, and with his right hand he inserts the elevator into the periodontal space, which becomes larger under the influence of the instrument. During manipulation, the periodontal fibers of the affected element are torn.

The elevator is inserted with rotational movements to a depth of 4–6 mm. Thanks to the efforts made by the dentist, the tooth is squeezed out of the alveolus. Similar manipulations are carried out to remove semi-retracted (partially exposed to the surface of the gum) and retracted (located in the thickness of the gum) elements.

A chisel or bur is used to remove the upper or lower front incisors, after which the dentist uses instruments to extract the roots. The remains of the root system are removed using narrow tweezers (for the upper jaw) or an angular elevator (for elements of the lower row).

Tools used

If a simple elimination requires only two main tools - forceps and an elevator, then in the case of a complex elimination everything is a little different and much more auxiliary devices are required. The instruments are specially developed for dental surgery, which allows all manipulations to be performed without causing severe harm (the level of mechanical damage is minimized).

To extract a molar or premolar, forceps, a bur, an excavator or an elevator are used, and during surgery a scalpel, hammer, scissors, and chisel are used. Let's take a closer look at what the role is and in what situations each of the tools is used.

• forceps. They are used in situations where the coronal part has been preserved and the roots are located in such a way that they can be grasped with an instrument. The specialist sets the axis of the crown to align with the axis of the forceps. For each group of teeth, forceps of a certain shape are designed, having a working part - cheeks, handles, lock;
• elevator. It is used in relation to molars (particularly the eighth) and premolars in the upper jaw. If necessary, using this instrument, the dental surgeon loosens the tooth (or its remains) along with the root, after which it is dislocated with forceps and removed from the gums;
• excavator. According to the principle of operation, it is similar to an elevator; it is used for deep fractures of a molar or premolar. It has an angular working surface, making it easy to penetrate into the hole;
• bit. It is used to eliminate the outer wall of the alveolar process. It is often necessary in a situation where a tooth breaks off and it is not possible to get it out using an elevator or excavator;
• hammer. Its help is resorted to in cases where a tooth is removed using a chisel. The dentist places the instrument in the area between the root and the hole, and at this time his assistant, using a hammer, makes several blows to this area;
• scalpel. Often, complex removal requires making a small incision with minimal trauma. For this purpose, a scalpel is used;
• drill. A drill is usually used during separation, removal of multi-rooted teeth, or removal of bone tissue surrounding a molar or premolar. In such situations, the dental tissue is sawed and removed piece by piece. This is not a simple procedure; it requires sufficient qualifications of a specialist. It is more advisable to resort to it if the root canals have already been previously filled or when the last molar is growing incorrectly (in a horizontal position).

A-Medic dentistry practices complex tooth extraction in Moscow. Qualified specialists work here. For high-quality removal during surgical intervention, the above-described instruments are used. Additionally, the clinic provides all necessary manipulations and services: hemostatic sponge, anesthesia (conduction, infiltration, application), preparation, dressing (using Trichopolum or Alvogil), removal and application of sutures. To make an appointment, just call the numbers provided or fill out an application on the clinic’s official website, after which the administrator will contact you.

What instruments are used to remove teeth?

Dental forceps have been and remain tools for removing teeth. For certain groups of teeth, a different type of forceps is used, since our teeth have different structures and are located differently in the dentition. For example, to remove the upper anterior tooth and the maxillary canine, there are straight forceps, and the remaining upper teeth are removed using S-shaped ones. The incisors of the lower jaw are pulled out using forceps curved at 90º with narrow cheeks (the part of the forceps that grasps the crown or root of the tooth being removed). The fangs and the two teeth following them are pulled with forceps, on the contrary, with wide cheeks. To remove large molars of the lower jaw, forceps with spikes that go between the roots are used.

Healing process after surgery

After surgery, the recovery period begins. The duration of its continuation is individual, as a rule, 1-2 days. In particularly advanced clinical situations, negative symptoms may persist for about 5-7 days. After a few hours, the effect of the anesthetic wears off, causing the patient to experience severe discomfort. If the pain is pronounced and does not go away on its own, experts prescribe non-steroidal anti-inflammatory drugs and analgesics.

The day after the operation, redness and slight swelling may occur in the area affected by surgical instruments. It gradually goes away on its own when the blood supply to the area is normalized. Sometimes the patient needs to take antibacterial agents (as prescribed by the attending physician).

Immediately after tooth extraction, bleeding may occur. This is due to the fact that a small bloody clot appears in the formed hole. Most often, it can be stopped in the dental chair, but for some, the hemorrhage continues for another 1-2 days. Prolonged bleeding may be due to a number of factors, such as high blood pressure or a bleeding disorder.

To avoid the appearance of hemorrhagic syndrome, it is important to strictly follow all the instructions of the surgeon. People suffering from hypertension are advised to drink motherwort tincture before tooth extraction. With its help, the functioning of the nervous system is normalized and there will be no surges in blood pressure. To monitor the healing process after surgery, you need to see a dental surgeon on days 5-7. There is usually no need to remove sutures as they dissolve on their own. To avoid complications during the recovery period, the following measures are required:

• During the first days, it is recommended to brush your teeth with a soft brush and be especially careful so as not to touch the soft tissues. This will avoid bleeding;
• You should not eat food for the first 2-4 hours. Throughout the entire recovery period, only soft foods and drinks at room temperature are recommended. Chewing on the operated side is prohibited;
• do not rinse your mouth or take baths for the first 24 hours;
• do not undergo strenuous physical activity. Such actions cause an increase in blood pressure, which can lead to hemorrhage.

Laser

The use of laser is one of the greatest achievements of medicine in general and dentistry in particular. In addition to making the dentist’s work easier, the device provides patients with a comfortable procedure and a fairly quick, painless recovery. The laser will not terrify a person, as can happen, for example, with a drill, because it works completely silently.

Laser

In general, in dentistry, lasers are used to treat shallow caries, install implants, treat gums, remove plaque, and even whiten teeth. When applied to the process of tooth extraction, the laser allows for a careful incision of the gums (in this case, the beam stops the capillaries, which means there will be no bleeding and severe trauma to the tissue), a more careful separation of the roots, as well as antiseptic treatment of the wound and restoration of damaged tissue.

Video of wisdom tooth removal using laser

Complex tooth extraction in Moscow: reviews of treatment at A-Medic

Olga, 41 years old. Last month I had an operation to remove a tooth at A-Medic dentistry. I made an appointment with Ziyad Ganiev without any problems. He is a true professional in his field. The procedure was successful, the doctor gave recommendations, followed them completely, and there were no complications.

Pavel, 27 years old. For several years now I have been receiving treatment only at the A-Medic clinic. Recently my wisdom teeth started to erupt and hurt a lot. The doctor advised to remove it. Removal took place quickly and without any discomfort. I recommend A-Medic dentistry to everyone.

Natalya, 32 years old. "A-Medic" is my favorite dentistry. The atmosphere in the room is pleasant, the doctors are experienced, making an appointment is not difficult. The other day I needed to remove the eight. My friends told me that this would be a difficult and painful operation. I signed up for removal with the Blazhentseva Rada. The operation took place in just a few minutes, and the recovery period took only two days.

Semi-retinated tooth

In principle, the method of removing such a tooth is no different from removing a completely impacted tooth. But, as a rule, it is a little easier, because the tooth is not so deep. The main stages are essentially the same: anesthesia, creating access to the tooth (and sometimes you can do without incisions), fragmentation (dividing the tooth into parts) and, in fact, removing the teeth in parts.

After removing the lower semi-impacted tooth, sutures are placed on the socket; in the area of ​​the upper wisdom teeth, sutures are not necessary.

Removing a tooth root using forceps

First, the doctor separates the periodontal tissue from the root so that the exposed part of the root can be easily grabbed with forceps. If this is difficult to do, the doctor separates the periosteum and the edge of the mucosa from the socket. It is much more difficult to remove upper teeth than lower teeth, so bayonet-shaped and S-shaped forceps are used for this. The doctor places the instrument as tightly as possible and makes rotational movements with it. If the tissues surrounding the tooth are affected by an inflammatory process, then the problematic root can be extracted quite quickly. The most difficult teeth in this regard are the canines and lower molars, since they have large alveolar processes.

Piezo device

Along with a laser, a piezoelectric device is another modern device that makes the dental treatment process more comfortable and safe. The device generates ultrasonic waves that replace a traditional drill. It works almost silently; when removing teeth, it allows you to make incisions in the gums, the teeth themselves, and bone tissue. In this case, the cuts are made using ultrasonic vibrations, and the tip of the device does not come into contact with the surface being treated. Due to this, the tissues are practically not injured, the operation is carried out with high precision even in difficult-to-reach areas.

Piezo device

Is it necessary to remove tooth roots?

The issue of tooth root removal can only be decided by your attending dentist based on the examination and the X-ray obtained. If it is not a source of infection and the tissues surrounding it are healthy, then the root can be used in the future as a support for an artificial crown, having previously “extended” it using a stump tab. Tooth root extraction is highly recommended in the following situations:

• a cyst has formed on the root of the tooth;
• the tooth was severely damaged by caries;
• root fracture;
• one of the walls of the tooth has broken off, and the chip goes deep into the gums;
• There is severe tooth mobility caused by periodontal diseases.

Tooth root removal using an elevator

In cases where the tooth root is located very deep and is difficult to reach with forceps, an elevator is used to remove it. The doctor inserts this instrument into the narrow gap between the edge of the hole and the root, and then rotates it while simultaneously pressing lightly. With these movements, the periodontal ligaments holding the root are torn. Using the elevator as a kind of lever, the doctor seems to push the root out of the hole. Even if it does not come out of the gum completely, the exposed part is enough to pull it out with forceps.