Tooth Extraction : Removal Of Impacted Tooth

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 erupt through the gumline, and instead remain trapped (or, impacted) beneath the bone in the jaw.
 
With this dental procedure code, the tooth in question is completely covered by a layer of bone, and is referred to as either “completely bony” or “full bony.” This is further complicated because such teeth often come in horizontally instead of vertically, causing the tooth to traject at an angle, interfering with adjacent teeth. An impacted tooth can also become infected, and it is because of these two reasons they 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. Surgical extraction is covered under a separate dental code, and can also be referred to as an “open” extraction.
 
From a procedural standpoint, a surgical extraction of an impacted tooth 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, 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 the bone along the side of the jaw that is encasing the tooth.
 
Once the flap is created, your dentist will use a surgical hand-piece to gently layer away the bone providing access to the tooth for extraction. Once enough bone has been removed and the crown of the tooth is fully visible, 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.