Treatments · Extractions and Oral Surgery

Extractions and Oral Surgery

Extraction is the last resort for teeth that cannot be saved; root canal treatment, gum treatment and restoration are considered first. Impacted teeth, root-tip inflammation and some soft-tissue problems are solved with minor surgical procedures.

When is extraction needed?

• Teeth too decayed or fractured to be saved by root canal treatment
• Loose teeth that have lost their support to advanced gum disease
• Impacted or partially erupted wisdom teeth that cause problems
• Planned extractions to create space in orthodontic treatment
• Retained milk teeth, extra teeth

Simple extraction

Under local anaesthesia the tooth is gently loosened and removed with special instruments; it takes a few minutes. You feel pressure but no pain. Gauze is placed in the socket and bitten on for 30 minutes.

Surgical extraction and impacted teeth

For fractured roots, impacted wisdom teeth and teeth inside the bone, the gum is opened, some bone is removed if needed and the tooth is divided and removed; stitches are then placed. The procedure takes 20–45 minutes. For teeth close to the lower-jaw nerve or the upper sinus, the position is first determined with a CT scan.

Other minor surgery

• Apicoectomy: surgical cleaning of root-tip inflammation that has not healed despite root canal treatment.
• Cysts and small lesions: removal of small cysts in the jawbone, with pathology when needed.
• Frenectomy: correction of a tongue-tie or lip-tie that affects speech, feeding or causes gum recession.
• Preparation for implants: bone grafting, sinus lift. See Dental implants.

Step by step

1. Assessment: X-ray; blood thinners, diabetes, heart disease and bisphosphonate use are reviewed; your physician is consulted if needed.
2. Anaesthesia: local; sedation can be discussed for anxious patients.
3. Extraction / operation: simple or surgical as described above.
4. Aftercare instructions: gauze, medication, diet and smoking advice given in writing.
5. Review: stitches removed at 7–10 days after surgical extraction; then prosthetic planning for the gap.

Duration

• Simple extraction: 5–15 min; the gum closes in 1–2 weeks
• Impacted wisdom tooth: 20–45 min; swelling 3–4 days, full healing 2 weeks
• Apicoectomy: 30–60 min
• Bone healing (for an implant): 2–3 months; in suitable cases the implant is placed at the time of extraction

International patients: allow at least 3–4 days in Istanbul after a surgical extraction before flying, and 7–10 days if stitches are to be removed here.

Aftercare

1. Bite on the gauze for 30 minutes, then remove it. If bleeding continues, press with clean gauze for another 30 minutes.
2. For the first 24 hours do not spit, rinse, use a straw or smoke; the clot must be protected.
3. Do not eat until the numbness has worn off; then warm, soft food, chewing on the other side.
4. Cold compresses on the outside on the first day (20 minutes on, 20 off) for swelling.
5. Take the prescribed painkiller/antibiotic as directed; aspirin increases bleeding, so do not take it unless advised.
6. From the next day, gentle rinsing with warm salt water; stitches are removed at 7–10 days.

Dry socket

If the clot is lost, severe pain radiating to the ear starts on day 2–4. Smoking, sucking and early rinsing increase the risk. It does not resolve on its own; the dentist cleans the socket and places a dressing, and it eases within a few days.