Tooth Extraction (Extraction): Clinical Indications, Surgical Protocols, and the Healing Process
In our clinical practice, in line with the principles of preventive dentistry, our primary goal is always to preserve and restore the patient's natural teeth in the mouth. However, in some cases, tooth extraction (extraction) becomes an inevitable surgical procedure due to the complete loss of tissue integrity, the formation of infection foci that damage the surrounding bone tissue, or the requirements of orthodontic planning. Tooth extraction is not merely a simple procedure to remove a tooth; it is a sterile surgical intervention that requires full compliance with maxillofacial surgery principles.
Indications for Tooth Extraction: In Which Cases Is It Performed?
As clinicians, when deciding on tooth extraction, we comprehensively evaluate the radiological and examination findings in the clinic. The main clinical situations that make this intervention necessary are as follows:
Advanced Loss of Tooth Structure: Teeth whose crown (superstructure) has been completely destroyed due to decay or trauma, whose supporting tissue at the root tips is absent, and which are too weak to be saved with root canal treatment or post-core restoration.
Advanced Periodontal (Gum) Diseases: Teeth showing advanced mobility due to the extensive resorption of the alveolar bone surrounding the teeth and that can no longer function.
Fractured and Complicated Roots: Tooth roots with vertical cracks at the root tip or roots that cannot be saved because they are fractured within the jawbone.
Impacted and Partially Impacted Teeth: Especially the impaction of wisdom teeth in the jawbone, which cause acute pericoronitis attacks, resorption in adjacent tooth roots, or orthodontic arch crowding.
Orthodontic Indications: Planned extractions performed to gain space in cases of jaw crowding so that teeth can be aligned in a proper row (serial extraction protocols).
Focal Infection Sources: Non-restorable teeth with chronic apical infection that threaten systemic health (for example, before heart valve disorders or organ transplantation).
Clinical Evaluation and Preoperative Preparation
Before the surgical procedure, the patient's systemic medical history must be carefully obtained. In individuals using blood-thinning (anticoagulant) medications, medication management is planned in consultation with the relevant physician. Surgical risks are assessed in advance in patients with uncontrolled hypertension, diabetes, or a history of active bisphosphonate treatment.
Periapical or panoramic radiographs must be used to examine the anatomical form and curvature of the roots, as well as their proximity to the jaw nerves or maxillary sinus cavities.
Types of Surgical Extraction: Simple and Surgical Extraction
Depending on the tooth's position in the mouth and root structure, two different extraction protocols are applied:
Simple (Using Forceps and Elevators) Extraction: The standard method used for erupted teeth that retain their anatomical form and have crown integrity. Under local anesthesia, separation of the gingiva from the tooth (sindesmotomy) is performed. Using hand instruments called elevators, the tooth is gently luxated (mobilized) within the bone and removed from the extraction socket with the help of forceps.
Surgical (Complicated) Extraction: The protocol used for teeth with separated or hooked roots, crowns fractured at gingival level, or impacted teeth. In this method, the gingiva is lifted to create a flap, if necessary a degree of removal (osteotomy) is performed from the bone tissue using rotary bur systems, or the tooth is sectioned from the roots and removed in pieces. After the procedure, the area is irrigated with sterile saline and sutures are placed to ensure mucosal integrity.
Post-Extraction Healing Process (Socket Healing)
Immediately after the tooth is extracted, clotting (blood clot formation) occurs within the empty socket. This clot acts as a biological barrier that protects the wound site and provides a foundation for the formation of new bone tissue. The basic rules to observe after extraction are as follows:
The sterile gauze pad placed by the clinician should be bitten down firmly for 30 minutes to stop the bleeding; during this time, the pad should not be changed frequently.
During the first 24 hours, to prevent the clot from dislodging (and to avoid the development of alveolitis / dry socket), do not spit, rinse, smoke, or use a straw.
On the first day, a cold compress (ice application) should be applied externally to the wound area to minimize the risk of swelling.
Hot foods should be avoided in the diet, and a lukewarm, soft diet should be preferred on the first day. Oral hygiene should not be neglected, but direct contact with the extraction area by a brush should be avoided on the first day.
