Surgical Extractions

A surgical extraction requires one or more of the following: incision into the gum tissue (flap elevation), removal of bone covering the tooth, or sectioning the tooth into pieces for removal. If a tooth cannot be grasped with forceps and improved out of the socket in one piece, it is a surgical case.

Your dentist recognized factors that increase surgical complexity: root curvature near a nerve, deep impaction, extensive decay below the bone level, ankylosis, or medical conditions requiring sedation. Specialists have advanced training, three-dimensional imaging, and the surgical instrumentation to handle these cases safely.

Wisdom tooth removal is a type of surgical extraction, but not all surgical extractions involve wisdom teeth. Any tooth — front or back — may require a surgical approach if it is broken, impacted, ankylosed, or has compromised root anatomy. The technique is similar: flap, bone removal if needed, tooth sectioning, and controlled delivery.

It depends on the complexity and your comfort level. A single surgical extraction can often be performed comfortably under local anesthesia alone. For multiple surgical extractions, especially in the posterior jaw near nerve structures, or for patients with dental anxiety, IV sedation provides a comfortable, amnesia-producing experience.

A simple extraction removes a tooth that is fully visible above the gum line using elevation and forceps — no incision required. A surgical extraction involves making a small gum tissue incision, possibly removing some bone, and sometimes sectioning the tooth into pieces for easier removal. Impacted teeth, broken teeth below the gum line, and teeth with curved or fused roots require surgical extraction.

Tooth sectioning means cutting the tooth into two or more pieces using a surgical bur. For a two-rooted lower molar, we cut between the roots at the furcation, then remove each root independently. This dramatically reduces the force needed and the amount of bone that must be removed — which means better preservation of bone and a smaller surgical site.

The risk is higher than with simple extractions when the roots are close to the inferior alveolar nerve or lingual nerve. This is precisely why CBCT imaging is critical — it shows us the three-dimensional relationship between the root tips and the nerve canal. When roots are intimately associated with the nerve, we may recommend a coronectomy (removing only the crown and leaving the roots) as a safer alternative.

Most patients experience peak swelling at days 2-3, with gradual improvement over the following week. Pain is managed with prescribed medication and alternating ibuprofen and acetaminophen. We recommend 2-3 days of rest, soft foods for 7-10 days, no straws or smoking for one week, and gentle salt water rinses starting day 2. Most patients return to work within 2-3 days.

Yes. In fact, infected teeth often require surgical extraction because the infection has destroyed surrounding bone or the tooth has fractured from internal decay. We may place you on antibiotics for 24-48 hours before surgery to reduce acute inflammation, but delaying extraction indefinitely is rarely appropriate when the tooth is the source of infection.

We use CBCT 3D imaging to evaluate root anatomy, proximity to nerves and sinuses, and bone density before surgery. This pre-surgical planning prevents surprises during the procedure. We use piezoelectric instruments for precise bone removal, and IV sedation ensures you are completely comfortable throughout. Complication rates are significantly lower with this level of planning and technology.

The flap is sutured closed, so unlike a simple extraction there is typically no open socket visible. The sutures hold the tissue in place while healing occurs. Some minor gapping may occur as swelling resolves, but the tissue will close fully within 2-3 weeks.

This is not uncommon with curved, dilacerated, or brittle roots. If it happens, we locate the fragment using direct visualization or imaging, then retrieve it with root tip picks and small elevators. In very rare cases where a tiny root fragment is deep, close to the nerve, and not infected, it may be deliberately left if retrieval carries greater risk than the fragment itself.

Surgical extraction fees depend on complexity, the number of teeth, whether bone grafting is performed simultaneously, and the type of sedation. Most dental insurance covers a significant portion of surgical extractions. We provide a detailed cost estimate after your consultation and CBCT evaluation.

In most cases, we do not ask patients to stop blood thinners for dental extractions. The bleeding risk from continuing blood thinners is generally lower than the clotting risk from stopping them. We use local hemostatic measures — suturing, PRF, hemostatic agents, and pressure — to manage surgical bleeding. However, always disclose all medications during your consultation so we can coordinate with your physician if needed.

An oral and maxillofacial surgeon completes 4-6 years of hospital-based surgical residency after dental school. General dentists may perform some surgical extractions but lack the same depth of surgical training. At ADSC, Dr. Ostovar has extensive implant training, and complex surgical cases that fall outside general-practice scope are referred to trusted oral surgeons.