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Complex extraction

Extraction is the term used to describe the removal of a tooth. Extraction is said to be “complex” when the procedure involves modifying the tissue and bone that supports the tooth (e.g., some procedures require a flap, i.e., cutting gums and removing bone in order to remove the tooth). The dentist will evaluate the tooth or teeth to be extracted according to several parameters including:

  • Their position;
  • The space available to reach them (opening of the mouth);
  • The health of the tissues and the presence of infection around the edges;
  • The presence of carious lesions on the teeth to be treated or on adjacent teeth;
  • The presence of restorations on the teeth to be treated or on adjacent teeth;
  • The presence of cracks or fractures on the teeth to be treated or on adjacent teeth;
  • The presence of periodontal (gum) disease around the edges.

The dentist will then determine whether these teeth can be considered as “simple” or “complex” extractions.

  • Tooth too decayed (impossibility of making a durable restoration);
  • Tooth too decayed under the gumline;
  • Tooth fractured under the bone;
  • Tooth fractured at the root level;
  • Tooth with advanced periodontal disease;
  • Tooth misplaced;
  • Tooth to be extracted due to lack of space or impacted tooth (often in cases of orthodontics);
  • Tooth difficult to reach for hygienic reasons;
  • Ankylosed tooth, i. e. welded to the bone;
  • Etc.

Disadvantages

  • The procedure is often stressful for the patient;
  • The recovery time varies according to the procedure and the patient (age, state of health, etc.);
  • The procedure requires a rest period or a temporary slowdown in activities;
  • The procedure generally requires the use of painkillers;
  • The procedure occasionally requires the use of antibiotics.

Risks and consequences of not treating

  • Infection of the tooth and/or surrounding tissues, causing bleeding, pus, swelling, discomfort and pain;
  • Possibility of carious lesions to neighbouring teeth;
  • Possibility of periodontal (gum) disease and bone loss around adjacent teeth due to difficulty of access for hygienic purposes;
  • Possibility of tongue or soft tissue injuries around the tooth to be extracted if the edges are broken, fractured, or sharp.

Processing steps and times

  • First appointment:  
    • Consultation with review of the patient’s dental and medical history;
    • Clinical and radiological examination of the tooth or teeth to be extracted;
    • Cost estimates.
  • Second appointment:
    • Extraction of the selected teeth;
    • Stitches (required);
    • Prescription of antibiotics and/or painkillers (as appropriate).
  • Third appointment:
    • Healing follow-up and removal of sutures (depending on the type of sutures used).

Postoperative indications

Please note that these recommendations are provided for information purposes only and that the best recommendations are those of your dentist or specialist who performed the surgery. The following is a list of the most common recommendations from practitioners:

  • Take prescribed or recommended painkillers;
  • Take the prescribed antibiotics;
  • Use a prescribed antiseptic mouthwash according to its recommendations;
  • Avoid drinking from a straw, spitting, and smoking for the first 24 hours;
  • Apply ice for periods of 10 to 15 minutes alternating with a rest period;
  • Avoid brushing teeth near the wound for a few days;
  • Avoid intense sporting activities as recommended;
  • Avoid foods that are too acidic, very hot, salty, or have a lot of vinegar;
  • In case of bleeding, apply a sterile compress to the wound or a moist tea bag and maintain pressure for 15 minutes. When lying down, keep your head elevated by adding an extra pillow;
  • If they have been used, the stitches are fragile. Some are dissolvable, some are not. It is necessary to be informed of the specific care according to each case. It should be noted that sutures often fall off by themselves. Do not pull on the wires, do not cut them;
  • The recovery period following surgery varies from person to person depending on the complexity of the surgery and how the patient complies with post-operative advice;
  • Allow about two days of rest following surgery. The swelling will usually peak during this period;
  • The discomfort associated with surgery often occurs within the first five days.

Cost

  • Varies according to the number of teeth to be extracted and the complexity of the surgery;
  • The estimate of the interventions and costs will be given to you in writing;
  • It is possible to ask your insurer for a predetermination. This will make it easier to reimburse your benefits based on your dental coverage.

Restrictions

The risks and consequences in terms of benefits are always assessed before the procedure. In some cases, the dentist or maxillofacial surgeon may choose not to extract one or more teeth. Examples of untreated cases:

  • Teeth included under the bone and without symptoms (e. g. canines or premolars included);
  • Danger of damage to nerve structures with the possibility of too great a loss of permanent sensitivity (paresthesia);
  • There is too great a risk of damage to the maxillary sinus (upper teeth);
  • Patient’s medical condition.

You will be given a consent form to inform you about the issues involved in the surgery, to inform you about possible risks and complications, to provide you with post-operative advice and to ensure that all your questions have been answered. In the case of an extraction that is risky or out of your general dentist’s area of expertise, you may be referred to a maxillofacial surgeon, a dentist who specializes in more complex surgeries.

Alternative solutions

  • Wait and monitor the progress of the tooth to be extracted (not recommended);
  • Wait and monitor the included teeth with periodic radiological examination;
  • Clear the gums around teeth that are not sufficiently erupted to facilitate hygiene;
  • Repair cavities with the most appropriate temporary restoration possible on the affected teeth;
  • Treat and control the progression of gum disease around the affected teeth;
  • Temporarily polish broken, fractured or sharp areas;
  • Check hygiene as best as possible around teeth that are difficult to access.
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