Extraction of impacted teeth

Surgical tooth extraction is a slightly more complicated procedure than an „ordinary extraction”.

Impacted teeth are fully developed teeth that became „impacted” in the bone of maxilla or mandible. The tooth may be either totally or partially impacted, depending on whether the tooth is completely or just partially surrounded by the bone. Impaction affects e.g. third molars (wisdom teeth), upper central incisors and canines, and lower premolars.

The location of impacted wisdom teeth in the mandible may differ. We extract wisdom teeth positioned variously in a painless and effective way in our dental clinic.

Impacted teeth hinder the functioning of the oral cavity and may cause malocclusion and malalignment of other teeth.

Various causes for tooth impaction have been described – congenital or acquired, general or local. General etiological factors include vitamin deficiency (in particular, vitamin A and D – including rickets), various endocrine disorders, but – more importantly – problems with wisdom teeth can be inherited.

Local etiological factors include: premature loss of deciduous teeth, retained deciduous teeth, bone hypoplasia, inflammatory lesions, cysts, odontogenic and non-odontogenic neoplasms. Also, trauma to the maxilla and mandible may constitute the underlying cause.

• Prevention of periodontal pocket formation or periodontal pocket infection.
• Prevention of root resorption in adjacent teeth.
• Pressure on adjacent teeth, treatment of pain of unknown origin.
• Periodontal disease prevention.
• Maxillary and mandibular fracture prevention.
• Follicular cyst around the crown, or prevention of cyst formation.
• Improper alignment in the dental arch.
• Prosthodontic, esthetic, orthodontic indications.

Before the dentist makes the decision concerning extraction in such cases, the patient is referred for CBCT diagnostics. Computed tomography makes it possible to visualise the location of the tooth in detail, which, in turn, makes it possible to plan the procedure.

Extraction of impacted teeth is always a difficult procedure, and it is always related to a longer list of complications caused by atypical location or intraoperative complications that are impossible to predict.

• Injury of the inferior alveolar nerve during the extraction of lower third molars.
• Maxillary sinus perforation during the extraction of upper third molars.
• The occurrence of oronasal fistula during the extraction of upper canines.
• Injury of the crowns and the roots of adjacent teeth, leading to pulp necrosis.

After the procedure, the affected area is sutured, and a compressive dressing and cooling dressing is applied to the site. Antibiotic therapy and soft diet are indicated. Oedema and pain may be present for 2-3 days. Proper oral hygiene should be maintained, and anti-inflammatory mouthrinses and appropriate, post-operative toothbrushes recommended by the clinician should be used. Usually, a check-up appointment is performed one week afterwards, and the sutures are then removed.

After an impacted tooth has been extracted, there is significant bone loss which results from the fact that it is necessary to uncover the tooth and perform a fenestration in the bone in order to remove the tooth. In some cases, the site needs to be augmented using bone substitutes. That is how significant bone loss, smile aesthetics loss, as well as the mobility of adjacent teeth caused by the lack of bone support around the roots, can be prevented. Also, that is how we can develop appropriate osseous base for reconstructive treatment with the use of dental implants.