All patients know what tooth extraction entails, i.e. the removal of a compromised tooth or a tooth that is preventing orthodontic treatment, or of a dental remnant that is maintaining an infectious process.
It is worth remembering that tooth extractions are not done on request, but only if the tooth in question can no longer be maintained at the level of the dental arches. The tooth can be retained at any time.
Alveolar extraction involves regularization and preparation of the bone and the remaining soft tissues for prosthesis.
Although it may seem like an easy operation, in reality tooth extraction can be complicated depending on a number of factors including:
Roots of the tooth to be extracted –the time but also the complexity of the extraction is dictated by the number but also the disposition and angulation of the roots. Thus, a molar with two, three or even more roots will be more difficult to extract than an incisor with only one root. Premolars and molars often have curved roots, so there is a risk that they will break when extracted.
Tooth quality – a healthy tooth that is extracted if it crowds or impedes orthodontic treatment is easier to extract. On the other hand, a tooth with multiple carious processes is much more brittle, and pieces of it can break off at any time. Thus, the whole extraction process is much more complicated and there is a risk of not being able to apply the pliers because healthy tooth walls are no longer available.
Endodontic treatments in the anterior– contribute to ankylosing of the tooth and lead to a tedious extraction.
Location on the dental arch– it is much easier to extract a tooth that is in the front region than a posterior tooth masked by the soft tissues of the cheek lining.
Quality of periodontal tissues– a tooth that is affected by periodontal disease is much easier to extract because the ligaments that anchor it are destroyed. Most of the time, a tooth with periodontium damage has mobility, which makes it easier to extract.
In addition to this, there is also the positioning in relation to the underlying soft and hard tissues, i.e. the relationship to the supporting bone. In the case of teeth that have not erupted and have remained embedded in the bone, or teeth that are ankylosed, the only intervention that can mobilize them is alveolectomy, which also involves bone trepanning.
Alveoloplasty is mainly used when multiple extractions are to be performed. The aim of alveoloplasty is to obtain a smooth remaining bone crest, without irritative spurs causing injury. Since it is assumed that the patient will opt for edentulous space prosthesis, the mucosa and the bone that will support it must provide all the conditions for good adhesion, comfort and functionality.
Also, in order to maintain the occlusal relationship even after the extraction of neighboring and antagonist teeth, provisional and immediate dentures are indicated. In this way, the remaining teeth will not change their position until a definitive treatment plan is carried out.
Following extraction, wound suturing is recommended to help clot formation and rapid and proper healing of the post-extraction ridges.
