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Tooth extraction

Removal of teeth, roots is considered to be a routine of dental practice, since centuries. However, the technique of tooth extraction gained more and more importance. Extractions are performed for a wide variety of reasons. Painful, infected, non-restorable teeth, or those fractured in accident, loosened due to periodontitis are removed. Preparation for orthodontic treatments can also involve removal of teeth, to relieve crowding. Considering the actual requirements and possibilities tooth extraction is to be carried out with minimal damage in jawbone structures. Tooth extraction must be gentle, saving the adjacent bone structure and soft tissues, to allow the appropriate tooth replacement, placement of artificial root (implant) to maintain the mouth’s best aesthetical and functional conditions. If during tooth or root removal not enough tissues and functions have been saved, a second restorative surgery is necessary prior to the creation of the appropriate aesthetic and functional conditions.

The simplest and less radical method is reasonable both for patient and dentist.
Prior to every tooth extraction, thorough dental examination, panoramic X-ray, in special cases CT scan are recommended to diagnose, to define the exact conditions.
There are several procedures for toot removal, tooth extraction, in conformity with the individual conditions. Loose teeth can be extracted using simple forceps, due to low resistance. However, if a wisdom tooth is not erupted from the jawbone, it will generally be removed by piezo technology, by vibrations or by elevation. In more complicated case other bone drilling device is to be applied-

Typical tooth extraction minor surgery

Typical tooth extraction is made with an appropriate forceps, in local anaesthesia. The adjacent soft tissues (gum) and the bone edges are to be saved to the maximum extent possible. If it reveals, that the tooth cannot be sufficiently loosened in the usual way, it is reasonable to choose a special procedure instead of the forced extraction. This can be a surgical tooth extraction from uncovering or incision, can be made with elevator, by piezo technique, the tooth or root can be even loosened by vibrations.

Removal of wisdom teeth

Removal of upper, particularly lower wisdom teeth is an oral surgeon’s procedure, even in simple looking cases. Due to the size of the jawbones, the wisdom teeth have not enough room in the dental arch. Even if they erupt from the bone, they cause crowding, drifting the other teeth generally forward. If they are only half erupted from the bone and only part of the crown can be seen in the gum, the teeth become impacted, and infection sources can develop. Sometimes wisdom teeth don’t erupt from the gum at all, they cannot be seen in the oral cavity, and they can only be detected on panoramic X-ray.

The sophisticated devices (special surgical drills, piezo technology, lasers) are a great help to perform painless minimally invasive surgeries with high precisity, free from rough injuries, damages, preserving the adjacent soft tissues, teeth and bone.

It is reasonable to remove wisdom teeth one by one; lower and upper wisdom teeth of the same side can be removed at once, if the case doesn’t seem to be very complicated.

Tooth extraction under general anaesthesia

The Gaspar Medical Center’s anaesthesists, intensive care medicine specialists and devices, hospital rooms ensure an adequate background to the safety of procedures performed under general anaesthesia. 

Sometimes it is reasonable to make tooth removal under general anaesthesia, and multiple teeth can be removed at once.

Simultaneously with teeth removal other dental procedures, fillings, root canal treatment, implant placing, preparation of teeth for crowns, impression taking can be performed. 

Tooth removal and instant implants

In many cases, increasingly sophisticated dental implant technology and special implants with particular shape and surface allow the placement of the implant immediately after tooth removal, within the same surgical procedure.  The implant will be inserted into the extraction site. The minimally invasive tooth or root removal is a precondition of this procedure.
The tooth is to be removed without the slightest injury of bone and soft tissues. It is reasonable to loosen the tooth with piezoelectric device, and then to elevate if it is firmly anchored. Number and shape of roots and location can make the removal complicated; dividing the roots and tooth into pieces and removing the pieces individually should be considered.

The cavity of the removed roots is prepared with implant drill, and then the self-tapping implant root is screwed into the implant site. In case of sufficient stability a temporary crown can immediately be fitted. So, in favourable conditions, the removed tooth can immediately be replaced.

Removal of tooth root

Tooth roots can rarely be removed in a simple way with root forceps, without injuring the dental socket. Generally other devices, sometimes surgical uncovery ensures root removal without injury. When using ultrasonic piezo device, vibrating tips are placed between root and alveolar ridge bone. The ultrasonic vibrations loosen the root and it can easily be lifted. This technology is of prime importance, when an implant is to be placed immediately after root removal, into the extraction site. The alveolar ridge bone must be preserved in unfractured condition for this type of implantation.

Minimally invasive tooth removal by piezo technique

Piezoelectric procedures have been developed to perform gentle bone surgery 

Advantages of piezo technique
Bloodless operation site: excellent overview during the operation, the joint effect of vibration, fluid ejection, bubble effect, etc. results in a minimal bleeding during bone cutting.
Quicker bone healing: histological and biomolecular tests proved, that  after piezo surgical cutting the healing of the tissues is considerably quicker than when using rotating instruments. Morphological tests proved that there were considerably less inflamed cells in the implant cavity than in case of preparation with conventional drilling devices.

Removal of baby teeth

However the technique doesn’t basically differ from the removal of permanent teeth, the procedure has special aspects. Small patients require other treatment, more patience from the dental team. When removing baby teeth, special attention is to be paid to the tooth bud under them, or to the already erupting permanent teeth. Injuries of erupting teeth can cause disorders of appearance, shape, location.

Careless extraction of an upper central incisor in childhood, causing the injury of the permanent central incisor, can stigmatize the aesthetical appearance for the whole life. If the removal of baby tooth happens long time prior to the eruption of the permanent tooth, it is reasonable to have a space maintainer fitted, because the narrowing of this space may hinder the eruption of the replacing permanent tooth.