Name of the Procedure:

Common name(s): Erupted Tooth Extraction with Bone Removal
Technical/Medical term: Surgical Removal of Erupted Tooth Requiring Elevation of Mucoperiosteal Flap and Removal of Bone and/or Section of Tooth (D7210)

Summary

This procedure involves the surgical extraction of a tooth that has fully erupted but cannot be easily removed using simple extraction methods. The dentist or oral surgeon will need to lift the gums (mucoperiosteal flap), remove some bone, and possibly section the tooth into smaller parts to facilitate its removal.

Purpose

This procedure is performed to resolve issues such as severe tooth decay, infection, or damage that cannot be repaired with a simple extraction or other treatments. Its goal is to alleviate pain, prevent the spread of infection, and preserve oral health.

Indications

1. Severe tooth decay or damage
2. Infection or abscess
3. Broken or fractured tooth with complex root structure
4. Preparation for orthodontic treatment
5. Impaction or obstruction by neighboring teeth

Preparation

• Avoid eating or drinking for 6-8 hours before the procedure if general anesthesia will be used.
• Adjust or stop certain medications as advised by the healthcare provider.
• Complete any required diagnostic tests such as X-rays to evaluate the tooth and surrounding bone structure.

Procedure Description

1. Anesthesia: Local anesthesia is typically administered; general anesthesia may be used in certain cases.
2. Incision: The surgeon makes a small incision in the gum tissue to expose the tooth and surrounding bone.
3. Flap Elevation: The mucoperiosteal flap (section of gum tissue) is elevated to access the bone.
4. Bone Removal: Necessary bone removal is performed to free up the tooth.
5. Tooth Sectioning: The tooth may be sectioned into smaller parts to facilitate easier extraction.
6. Extraction: The tooth fragments are carefully removed.
7. Closure: The surgical site is cleaned and the gum flap is repositioned and sutured.

Tools/Equipment: Surgical handpieces, dental elevators, forceps, bone chisels.

Duration

The procedure typically takes between 30 to 60 minutes, depending on the complexity of the case.

Setting

This procedure is usually performed in a dental office, outpatient clinic, or surgical center.

Personnel

• Oral Surgeon or Dentist
• Dental Assistant or Operating Room Nurse
• Anesthesiologist or Certified Registered Nurse Anesthetist (if general anesthesia is used)

Risks and Complications

• Common risks: Bleeding, swelling, bruising, pain.
• Rare complications: Infection, nerve injury, dry socket (alveolar osteitis), sinus perforation, prolonged numbness or altered sensation.

Benefits

• Relief from pain and infection.
• Improved oral health enabling better function and aesthetics.

• Prevention of further complications associated with the problematic tooth.

  Recovery

• Soft diet and avoidance of hot foods and beverages for the first 24 hours.
• Ice packs applied to the face to reduce swelling and discomfort.
• Keeping the head elevated to minimize swelling during the first few days.
• Pain management using prescribed pain relievers.
• Follow-up appointments to monitor healing.

Alternatives

1. Non-surgical extraction: Suitable only for less complex cases where the tooth can be removed without surgical intervention.
2. Root canal therapy: An option if the tooth structure can be preserved.
3. Orthodontic treatment: In cases where tooth repositioning is an option to reduce impaction.

Pros and Cons: Surgery provides a definitive solution for complex cases where alternatives might not be feasible or effective. However, surgery carries higher risks and requires longer recovery compared to simpler extractions or interventions.

Patient Experience

During the procedure, patients are typically kept comfortable with anesthesia, experiencing pressure but not pain. After the procedure, patients may experience swelling, discomfort, and soreness, managed with prescribed pain medication and other comfort measures such as ice packs and specific post-operative care instructions.

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