Operative extraction of a retained tooth

This is a procedure concerning teeth that, due to their position (e.g. blocking by other teeth, abnormal growth direction), have remained in the bone without being visible in the oral cavity. This problem most commonly concerns wisdom teeth (eights), and canines in the jaw, as well as teeth extra, supernumerary and supernumerary permanent teeth in children and adolescents.

The surgical extraction of a tooth is a more complex procedure than a 'simple extraction'. It requires considerably more time and additional tools such as the Piezosurgery (piezosurgery) used to expose the tooth from the bone, a laser for bloodless soft tissue cutting, see - Laser therapy for additional levers and sutures for wound supplies.

Indications for the removal of retained teeth, are anticipated orthodontic or prosthetic measures, developing intraosseous dentigerous cysts of significant extent, as well as pressure on neighbouring teeth, resulting in the possibility of resorption of their roots. 

The procedure for the extraction of an impacted tooth should be carefully planned. The position of the tooth should be carefully determined, so that the actions leading to its extraction do not cause destruction of the surrounding structures - destruction of neighbouring teeth, damage to large blood vessels and nerves.

However, it should be borne in mind that the extraction of a retained tooth, is a difficult procedure, always fraught with more possible complications, due to the unusual location of the tooth, and the unforeseen intra-operative difficulties that can occur. 

The most common complications during extraction of retained teeth include: 

• damage to the inferior alveolar nerve during removal of the lower eights, 

• Perforation of the maxillary sinus during removal of the upper eights, 

• formation of an oro-nasal fistula during the removal of the upper trochlea, 

• damage to the crowns and roots of neighbouring teeth, resulting in their necrosis. 

After extraction of a retained tooth, a significant bone loss remains, associated with the need to expose the tooth and create a bone window to allow its extraction. In certain cases, it is advisable to replace the bone loss created after surgery with bone substitutes such as Bio-Oss. The purpose of this is to avoid severe bone loss in this area, loss of smile aesthetics, loosening of neighbouring teeth due to lack of bone support for their roots, and to create a proper bone base for reconstructive treatment with dental implants.