Simple and complex wisdom tooth removal. Features of complex tooth extraction

Tooth extraction can be simple or complex (surgical). The first is used to eliminate single-rooted or loose teeth, when nothing prevents their extraction. Complex removal requires the use of special instruments, medications and is performed with dissection of the gums or periosteum. Most often, such problems arise with wisdom teeth.

When is complex tooth extraction prescribed?

The technique of complex tooth extraction is indicated in the following clinical cases:

• presence of impacted (unerupted) wisdom teeth;
• dystopic (improperly positioned) “eights”;
• any removal of two- or three-rooted molars;
• the tooth root is severely curved or destroyed;
• fusion of jaw bone tissue with roots;
• the presence of a cyst or fistula;
• The tooth was previously treated with resorcinol-formalin paste, which is why it is too fragile.

This operation requires more time (about 30-40 minutes), strong anesthetics(lidocaine, articaine) and includes several stages.

Process and stages of complex tooth extraction

It all starts with careful preparation. X-ray diagnostics are required to determine the length and shape of the roots, the depth of the tooth and the complexity of the work ahead.

In the presence of inflammatory process appointed antibacterial therapy the day before the procedure. In addition to local anesthesia, sedation can additionally be used to relieve the patient’s psychological stress.

Technique for complex wisdom teeth removal:

1. incision of soft tissues and separation of the gums from the neck of the tooth;
2. if necessary, sawing out a section of bone tissue or sawing the interroot septum;
3. applying forceps to the crown, which are lowered all the way to the edge of the alveoli;
4. the cheeks of the forceps are clamped and fixed without excessive pressure;
5. then the tooth is rocked and removed from the socket;
6. suturing the gum.

Instruments for complex tooth extraction

During the operation, the surgeon uses a scalpel, scissors, chisel, suture material, and the tooth extraction itself is carried out using forceps, an elevator or a bur.

Forceps

They are used when the coronal part is completely preserved, and also when the position of the roots allows them to be well grasped by the cheeks of the instrument. In this case, the doctor determines the axis of the crown to align with the axis of the forceps, which can be straight, curved or S-shaped.

Elevator

Used for dystopic eights, teeth upper jaw, and also when the use of forceps is not possible. The elevator is lowered into the periodontal fissure and rotated around its axis. It acts like a wedge, tearing the ligaments and squeezing the tooth out of the socket.

Drill

When eliminating multi-rooted molars, it is necessary to first separate the roots with a drill. Dental crown also sawn and removed piece by piece. This is quite labor intensive and complex method. It is appropriate if root canals previously filled or when the wisdom tooth grows in a horizontal position.

Healing process after surgery

Tissue healing usually lasts 7-10 days and is painful for the patient. 2-3 hours after the procedure, the anesthesia wears off and It's a dull pain, which can be eliminated with an analgin tablet.

Swelling, redness and soreness of the mucous membrane should decrease every day. A slight itching in the surgical area indicates an intensive regeneration process. Usually, suture removal is not required; they “dissolve” on their own.

• do not eat or drink for 2-3 hours after the procedure;
• do not rinse, clean or heat the hole;
• on the first day after surgery, you should not do any rinsing, baths or lotions;
• try to chew food on the side opposite the socket.

Consequences and complications of tooth extraction

Complex tooth extraction can take a long time to heal. The most dangerous consequence operations – alveolitis. This is inflammation of the alveoli, which makes itself felt 2-3 days after surgery. Arises severe swelling mucous membrane, and half the face may swell, body temperature rises, and unpleasant putrid smell from mouth.

The reason for this complication is non-compliance with the rules of post-operative care or gross mistakes by the doctor during the operation. For example, fragments of roots remained in the hole, which caused suppuration.

At the first signs of alveolitis, you should immediately contact the dentist.

The safety of the operation depends on the correct technology and compliance with aseptic standards. You can find an experienced surgeon on our website. To do this, use a well-thought-out search system.

Extraction (the scientific name for tooth removal) is an operation and involves surgical intervention. In dental practice, simple and complex removal are distinguished. These procedures differ in the indications, anesthesia used and the instruments involved. Complex extraction is carried out when the tooth is partially hidden in the gum or its root system is tangled. When else is such an intervention indicated? Complex tooth extraction

Complex removal: characteristics and main differences

Complex removal is a surgical procedure in which extraction is carried out using strong anesthesia and non-standard instruments. The need for such intervention is determined anatomical features jaw structure, gum condition, severity pain syndrome. One of the most difficult manipulations is the one during which you need to remove the root. The process becomes more complicated if the root is broken or entangled in the alveolar formations.

After a difficult removal, the dentist definitely prescribes antibiotics, even if there are no signs of suppuration or inflammation. This is necessary to prevent the development infectious lesion. Another feature of the procedure is deep incisions in the gums, which are closed with sutures. The recovery period after such an operation lasts longer. Swelling or bruising often forms at the site of removal in the first hours.

What else is different about complex removal?

1. Anesthesia. For a simple operation, local or complete absence(for baby loose teeth). In case of difficult pain relief, only potent drugs are indicated.
2. Duration. A simple intervention lasts from 5 to 20 minutes. A complex operation takes place in several stages, total duration– 40-60 minutes.
3. Using special tools. Simple tooth extraction involves using only forceps. For complex removal, both forceps and elevators, luxators, and a drill are required. The purposes of using instruments are to lift or push back the gums, grab or cut the root.

Tooth extraction using an elevator

When is a complex tooth extraction prescribed?

The main indication for this procedure is the impossibility of removing a tooth with forceps alone due to the fact that access to it is blocked by bone or tissue. Common cases include partially erupted or unerupted wisdom teeth, incorrectly positioned wisdom teeth, removal of molars from the 2nd and more roots, and:

• the root area is destroyed;
• the root is twisted;
• the bone tissue has fused with the root;
• damage by cysts or fistulas;
• preliminary treatment with resorcinol-formalin paste, which negatively affected bone tissue.

How does the complex removal procedure work?

Before the actual extraction, preparation is carried out. First stage includes mandatory x-ray examination. The resulting image shows general state roots and exact location of the tooth in the jaw. If there is an inflammatory process, antibacterial therapy is prescribed a day before the procedure. In case of complex extraction, except local anesthesia Sedation may be used to relieve anxiety and tension.

For subsequent removal, several techniques are used, which differ in the tool used. The choice is influenced by the condition of the tooth and the depth of the root system.

Tool selection

Forceps

Indicated if the crown of the tooth is not destroyed, it clearly rises above the gum.

How the removal occurs:

1. The crown at the base is grabbed with forceps.
2. The surgeon performs swinging, smooth movements.
3. The amplitude increases until the root and alveoli rupture. The tooth is pulled out.

Elevator

It is used if the teeth extend beyond the border of the row.

The mechanism of action resembles a wedge. The elevator is placed in the periodontal fissure, then scrolled. Under this action, the ligaments are torn, the tooth is “squeezed out”.

Drill

It is used if the tooth has several roots or a resorcinol-formalin filling is installed. The tooth is being cut out.

Excavator

Used in cases of deep root or tooth fractures. The instrument has an angular surface, which makes it easy to insert it into the hole or move it between the alveoli.

The tooth gradually extends.

Bit

It is used in case of fracture of a unit, dense structure of bone tissue.

Dental chisel

The method is rarely used in dental practice; the chisel successfully replaces the drill.

How the removal occurs:

1. The chisel is placed between the hole and the root.
2. The tool is pressed with a special hammer.
3. The chisel moves towards the root system and alveolus.
4. The tooth is pulled out.

The general technique of complex extraction involves making an incision in the soft tissue and separating the gum from the crown, followed by sawing or sawing of the bone septum as indicated. The selected instrument is fixed, the tooth is rocked and removed. The procedure ends with suturing.

What are the possible complications?

The average duration of the rehabilitation period is 3-10 days. Immediately after the procedure, the patient feels residual symptoms - pain at the removal site, little bleeding, swelling, slight increase temperature. These signs correspond to the normal state and go away on their own over time.

A doctor's help is necessary if the following complications occur:

• heat;
• pus appears at the site of removal;
• prolonged heavy bleeding;
• severe swelling and pain.

The appearance of such symptoms is a signal that in the area extracted tooth an infection appeared. Immediate help is required, as delay threatens infection of neighboring organs.

Alveolitis sockets

Other possible complications include alveolitis. The condition develops against the background of inflammation of soft tissues. Requires hospital treatment. Other negative consequence– paresthesia. Characterized by loss of sensitivity of the tongue, lips, and chin. Develops after the dentist touches the facial nerve.

Discomfort and swelling persist for up to 7 days after the intervention. The first hours are especially painful, since after 2-3 hours the anesthetic effect stops and aching pain appears. If the operation went well, there are no complications, the dentist prescribes painkillers to reduce discomfort during the recovery period.

The presence of mild itching at the site of removal is a sign that an active process of tissue regeneration is occurring. Redness, swelling and pain in in good condition should gradually decrease. IN recovery period It's important to stick to the rules.

1. In the first 2-4 hours after complex extraction, do not eat, preferably do not drink.
2. Do not heat the well or rinse it. The removal site must not be touched with hands or foreign objects.
3. On the first day, lotions, baths, and rinsing are prohibited.
4. To speed up the recovery period, you need to chew food on the opposite side and drink through a straw.

Standard post-extraction care includes regular wound treatment with antiseptics, taking antibiotics and anesthetics (dosage and use are regulated by the dentist). In the first days after a complex removal, it is better to open your mouth halfway so as not to disturb the sutures.

Complex removal is a procedure in which special instruments are used and strong anesthesia is performed. The main indications for intervention are abnormal growth figure eights, violation of the integrity of a tooth or root, several roots for one tooth. It is carried out using forceps, an elevator, or a drill. The recovery period is long, and there is often swelling or bruising at the removal site.

Removal of wisdom teeth – essential procedure, the complexity of which, first of all, is due to the location of the eights and the unpredictability of their structure: they can have a different number of roots and be non-standardly located inside the jaw.

Naturally, the complexity of the procedure is always scary people the opportunity to experience severe pain. Previously, this was the case, but today, thanks to the development of pharmacology and the emergence of new medicines, the problem of pain during the removal of wisdom teeth does not exist. The patient may feel that their jaw will be manipulated, but there will be no pain.

The main problem with this procedure is that the vast majority of patients do not understand its essence. Because of this, they don’t go to the dentist. Considering possible complications from suppuration, it is impossible not to go to the doctors.

How is a wisdom tooth removed?

Dentists divide wisdom teeth removal into 2 types: simple and complex.

Simple wisdom tooth removal

During this procedure, dentists use only simple tools: forceps and elevators. The dentist does not use a scalpel, a gimlet, or divide the tooth root into parts. Because of this, simple wisdom tooth removal performed by a professional is considered a low-traumatic operation. Therefore, the patient does not feel pain after the anesthetic wears off.

A simple wisdom tooth removal consists of several stages:

It is worth noting that some doctors leave the hole as is, but some specialists prefer to suture it, especially if they are afraid of the possibility of its recurrence. infection or development of bleeding.

Majority patients Those who have gone through this procedure remember it with fear and try to avoid visiting dental office. This is explained by the increased pain of the procedure, its increased duration, the abundance of blood, and the duration of healing of the wound field.

The main difficulty of this procedure is that the doctor has to spend a long time preparing the crown of the figure eight and its roots for extraction. The surgeon is forced to excise the gum tissue, remove excess bone around the tooth socket and then separate the roots.

Today, dental equipment is most often used for these purposes. car with a set of drills and special tools. But not so long ago similar procedure a hammer and chisel were used.

Since wisdom teeth are most often placed in the jaw at non-standard angles, dentists must take a photo of the patient’s jaw before complex wisdom tooth removal. Some doctors do it for any wisdom tooth removal.

Herself procedure consists of the following steps:

Especially difficult remove impacted or semi-impacted wisdom teeth. Most often in the list of services dental clinics such procedures stand on a separate line. It's about about the removal of teeth that, for some reason, could not erupt through the gums or were partially erupted.

This problem occurs in many people and does not bother most people. special problems. But in some patients, the hidden eight begins to put pressure on the nearby seven, provoking strong painful sensations. Severe pain can also occur when the crown of a tooth destroys the hood of gum tissue from the inside, causing it to fester. In both cases, the patient needs urgent medical attention.

Each doctor determines the complexity of the operation on one's own. Moreover, this should be done on the basis of a full x-ray of the jaw. Most often, the complexity of the operation is determined by the spatial location of the figure eight in the hole. If it lies in the thickness of the bone almost entirely and is also located at a large angle to the adjacent tooth, then the operation will most likely take a very long time.

The doctor will have to not only cut the gum, but also cut out bone tissue to get to the coronal part of the figure eight and the roots. Only then can he separate them and remove them.

Modern methods of wisdom teeth removal

First of all, we are talking about painless removal. As mentioned above, this procedure is not today associated with severe pain during the operation. And all thanks to new anesthetics that doctors use in various situations.

At one time, dentists widely used Novocaine. This anesthetic was characterized by low toxicity, but it could cause serious allergic reactions up to anaphylactic shock. Therefore, scientists have developed more effective and safe medicines.

One of them was and remains Lidocaine. This drug is widely used to this day, but, as a rule, only in the most inexpensive clinics. They are gradually abandoning it. The fact is that despite the low toxicity and relative safety in terms of allergic reactions For persistent pain relief it is necessary to administer too large dosages.

Thus, when removing a wisdom tooth, doctors are forced to inject more than 10 ml of the drug into the anesthesia zone to achieve normal anesthesia. This leads to the patient feeling a crunching sensation in the tissue at the injection site, he may become dizzy, and his heart rate will increase. All this happens due to adrenaline, which is added to the anesthetic to increase the duration of its action.

Actually, in good clinics due to possible side effects prefer not to use lidocaine. Instead, more expensive but also more expensive ones are used modern drugs:

• Ultracaine.
• Ubistezin.
• Septanest et al.

To ensure that the patient does not feel anything during the injection itself, dentists today use carpule anesthesia. It is done with a special syringe into which a capsule containing an anesthetic is inserted. After it enters the tissue, it releases medicine already mixed with adrenaline in the right proportion.

By the way, carpules are often used for ordinary dental procedures. For example, if the elderly, children, pregnant women and disabled people need help.

What awaits patients after wisdom tooth removal?

Almost all patients inevitably experience pain. Duration and intensity Painful sensations will depend on how severely the surrounding tissues were injured during the operation. However, there are often cases when patients, even after complex operations did not complain of prolonged pain. This is explained by individual pain threshold the patient, the professionalism of the surgeon and the instruments used.

Some patients complain to doctors that it is not the socket of the extracted tooth that hurts, but the neighboring teeth and even the cheek. Also, in the first days after surgery, people undergoing surgery may experience difficulty swallowing. Painful sensations can radiate to the ear and even to the head.

If painful sensations persist for a long time after surgery, then most likely they are caused by an inflammatory process. As you know, any inflammation has a set characteristic symptoms, among which there is pain.

Small inflammatory the process in the operation area is not a significant pathology. If you follow your doctor's recommendations, it will go away quickly. But if this does not happen, you should immediately seek help.

Possible complications after wisdom teeth removal

Most often, complications arise in cases where the doctor has to remove inflamed tooth. By the evening after this procedure temperature the patient's body may rise to low-grade levels. However, this is not a cause for concern, but the norm. But if the temperature rises above 38 ° C, then this indicates the development of inflammation. In this case, the patient is recommended to reduce the temperature with Rapidol and Paracetamol. If it does not decrease after taking medications, then you need to go to the hospital.

Painful sensations cannot be considered a serious pathology. It is almost impossible to remove a wisdom tooth without pain. It appears after the anesthesia wears off. As a rule, pain goes away on the first day after surgery. If the painful sensations persist for a week, then this indicates the development of a serious inflammatory process. This means you need to consult your doctor.

Patients sometimes develop hematomas. Their appearance is due to the inaccessibility of the eight. When removing it, the doctor may touch a fairly large blood vessel. Bleeding in the tissue may cause a bruise on the face.

This complication does not pose any danger. Usually no trace remains of it within a few days. But if the appearance of a bruise is accompanied by swelling, a local increase in temperature and tissue soreness, then with such a complication you should urgently consult a doctor.

The most dangerous complication after wisdom tooth removal is considered bleeding. If the surgeon did everything correctly, then the blood from the hole stops flowing quickly enough. This often happens in the dentist's office. This happens due to the film that covers the hole and protects it from infections and food particles. But if a large vessel is damaged, the bleeding does not stop quickly. In this case, the doctor simply ligates the vessel and puts sutures on the hole.

But what to do if the bleeding starts at home and doesn’t stop? The easiest way is to influence the area surgical intervention cold. You can also put a bandage swab on the hole and press it with your teeth for 10-15 minutes. If after this the bleeding does not stop, then you need to run to the doctor.

To make the wound surface faster healed you need to follow the following recommendations:

• There is no need to explore the socket with your tongue after surgery, and even more so, you should not insert foreign objects into it.
• It is better not to brush your teeth during the day, so as not to accidentally remove the protective film from the wound.
• Do not rinse your mouth.
• Refrain from visiting the sauna or taking a hot bath.
• Do not heat the cheek on the sore side. Fever may provoke the development of an inflammatory process.

Don't forget about a check-up with your dentist.

Complex tooth extraction is an extraction during which the doctor uses several instruments. Even if the tooth was removed quickly, but forceps and an elevator were used during the intervention (technically the removal is not difficult), the removal is still considered difficult.

Such removal also includes gouging out the tooth with a chisel, sawing through the roots, and sawing out fragments of bone tissue. However, if during the removal process it was necessary to make an incision and cut out a flap, then it is called atypical.

Often, during the process of tooth extraction, it becomes necessary to use several tools at once (usually forceps and elevators). This is how roots and severely damaged teeth are often removed. First, the doctor tries to loosen the tooth or root with an elevator, and then dislocates it with forceps.

If there is a fracture of the crown or root of the tooth being removed, this may also require the use of additional instrumentation. For shallow fractures, you can try to dislocate the tooth with an elevator, but if the tooth breaks off deeply (the tip remains in the hole), it is more convenient to use an excavator.

The excavator has an angular working surface that easily penetrates the hole. They try to move this instrument between the wall of the alveolus and the tooth fragment, after which the tip is gradually dislocated and loosened. It is worth noting that the broken roots of the upper chewing teeth must be removed very carefully so as not to push them into the maxillary sinus.

Using a chisel

The chisel is used in cases where it is necessary to remove the outer wall of the alveolar process (if it is not possible to use a drill). Such situations happen when a tooth breaks off deeply and it is not possible to get it out with an elevator or excavator.

This instrument is also used when the surrounding bone is dense, and the elevator cannot be moved between the alveolar wall and the root. In such cases, the doctor places the working part of the chisel between the root and the hole, and then holds it tightly. The assistant applies several blows with a hammer to the chisel handle, after which the tool moves between the root and the wall of the alveoli. Next, they try to dislocate the tooth using the lever method (as when working with an elevator).

It is worth noting that these manipulations are not accompanied painful sensations with adequate local anesthesia. However, such removal leaves many “pleasant” memories for the patient.

Recently, doctors are trying less and less to use this complex removal technique, leaning more towards cutting out the roots with a drill.

Using a drill

In practice surgical dentistry drill needed:

• Firstly, for separation (sawing) of the tooth into separate parts.
• Secondly, to remove the bone tissue surrounding the tooth.

When removing damaged multi-rooted teeth (most often molars), it is not always possible to extract the tooth with forceps, since the crown or root of the tooth is fractured. In such cases, it is more effective to saw the tooth into several roots, and then remove them separately.

For this purpose, long diamond burs for the turbine tip are used. When removing molars lower jaw the tooth is sawed into two parts - distal and medial roots, which are then dislocated using an elevator. On the upper jaw, molars have three roots (palatal and two buccal), therefore the tooth is sawed into three parts (most often a T-shaped cut).

With this option of complex tooth extraction, the trauma to the surrounding mucous membrane and bone tissue is minimal, which is why doctors have recently been increasingly using this technique.

Tooth cutting from bone is carried out using carbide burs for a straight tip using water cooling. Impacted wisdom teeth are removed using this method. supernumerary teeth, as well as the tips of the roots with thick outer wall alveolar process. As a rule, cutting out a tooth begins after making an incision and cutting out a mucoperiosteal flap, so such removal is considered atypical.