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Transalveolar Extraction (Surgical Tooth Removal)

Definition

Transalveolar extraction is commonly known as surgical extraction or an open extraction of a tooth. The method is employed when normal forceps extraction is not possible due to various difficulties. Generally if a tooth fractures during regular extraction, surgical approach is necessary to remove the root fragments.

Indications

A transalveolar extraction is conducted when :

  • Any tooth that can not be extracted by normal use of forceps or elevators.
  • A tooth with previous history of attempted and failed extraction.
  • Extraction of the tooth that has undergone root canal therapy.
  • Fractured or retained tooth that are not approachable to dental forceps.
  • The tooth is ankylosed to the underlying bone (fused tooth).
  • Tooth with irregular and curved roots that is more likely to fracture during a regular extraction.
  • Sclerosis of bone.
  • Impacted teeth or embedded teeth that are partially emerged in oral cavity- most commonly the wisdom tooth.
  • Teeth associated with diseases such as dental cysts, tumors , periapical granulomas.
  • Grossly decayed teeth with root caries or internal resorption
  • Teeth lie very close to major dental nerves where the nerve damage is possible during a forceps extraction

Before Surgery

Pre-operative dental x-rays are mandatory before a surgical extraction. A dental x-ray gives the complete picture of the tooth anatomy, surrounding vital structures and presence of possible complications. The other pre-extraction assessments include identifying the presence of an infection, tooth accessibility and mouth opening assessment of the patient.

If an infection is present at the site of the surgery, the use of antibiotics is recommended and the surgery delayed until the infection is under control. Not only can an infection reduce the effects of anesthetics but there is also a possibility of the infection spreading and causing complications.

Procedure

Patient’s age and overall general health is also a major factor in determining the extraction method. The actual procedure of transalveolar extractions involves anesthetizing the operative site using local anesthetic agents such as lignocaine. An incision is made over the oral mucosa to access the bone forming the socket of the tooth. The approach of the incision depends on the location of the involved tooth, bone density and surrounding anatomical structures.

The bone surrounding the tooth is removed by using rotary instruments, chisels or instruments used for trimming the bone. Once tooth becomes completely accessible, it is removed either as a whole or by cutting it in to segments and removing them one by one. After the tooth is extracted the operation site is irrigated and the incision is closed by placing sutures.

After Surgery

The post extraction care includes the use of analgesics and antibiotics. The patient is advised to maintain good oral hygiene to avoid any infection at the site of incision. Immediate consumption of hot beverages or coarse foods is to be avoided as it may trigger bleeding. The patient is also advised to abstain from use of straws, vigorous tooth brushing and rinsing the mouth for next few hours. Smoking should also be avoided till the sutures are removed and wounds are healed as it may lead to delayed wound healing.


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