Name of the Procedure:

Common name(s): Removal of Impacted Tooth Technical/medical term: Removal of Impacted Tooth - Completely Bony (HCPCS Code D7241)

Summary

The removal of a completely bony impacted tooth is a surgical procedure to extract a tooth that is fully encased in bone and has not erupted through the gum line. This procedure is often necessary when the impacted tooth causes pain, infection, or alignment issues with other teeth.

Purpose

The procedure addresses medical conditions such as:

• Severe pain due to impaction
• Infection or abscess formation
• Cyst or tumor development
• Damage to adjacent teeth
• Orthodontic issues caused by misalignment

The primary goal is to alleviate pain, prevent further dental complications, and maintain oral health.

Indications

• Persistent pain in the jaw or gums
• Swelling or infection around a tooth
• Damage to neighboring teeth
• Difficulty opening the mouth or chewing
• Dentist's diagnosis of an impacted tooth through X-ray

Preparation

• Fasting for several hours prior to the procedure, if general anesthesia is used
• Adjustment or temporary discontinuation of certain medications, as advised by the healthcare provider
• Pre-procedure assessment including dental X-rays and possibly a blood test

Procedure Description

1. Administration of local anesthesia and/or sedation to ensure comfort.
2. An incision is made in the gum to expose the impacted tooth.
3. Removal of the bone surrounding the tooth using specialized dental tools.
4. Extraction of the tooth, sometimes in pieces if necessary.
5. Cleaning of the surgical site to remove debris or infection.
6. Stitching the gum incision to aid in healing.

Tools include dental drills, forceps, and sometimes specialized ultrasonic devices. Anesthesia options vary and may include local anesthesia, sedation, or general anesthesia depending on the complexity of the extraction and the patient's comfort level.

Duration

The procedure typically takes between 45 minutes to an hour, though it can vary based on the complexity of the tooth impaction.

Setting

The procedure can be performed in a dental office, outpatient clinic, or surgical center.

Personnel

• Oral surgeon or specialized dentist
• Dental assistants
• Anesthesiologist or sedation nurse (if sedation or general anesthesia is used)

Risks and Complications

Common risks include:

• Bleeding
• Swelling
• Infection at the extraction site
• Dry socket (a painful condition that occurs if the blood clot is dislodged)
• Nerve injury leading to temporary or permanent numbness

Benefits

• Relief from pain and discomfort
• Prevention of further dental complications
• Improved oral health and hygiene
• Potential for realignment of teeth if combined with orthodontic treatment

Benefits are typically realized within a few days to weeks post-surgery, as healing progresses.

Recovery

• Post-procedure care includes prescribed pain management, antibiotics, and anti-inflammatory medications.
• Instructions may include applying ice packs, maintaining oral hygiene with gentle rinsing, and avoiding strenuous activity.
• Soft diet recommendations for a few days following the procedure.
• Full recovery and healing typically occur within 1 to 2 weeks, with a follow-up appointment scheduled to monitor healing.

Alternatives

• Monitoring and managing symptoms conservatively if the impacted tooth is not causing severe issues.
• Orthodontic treatment to address misalignment without extraction (not always feasible with completely bony impactions).
• Each alternative has specific benefits and risks, and the choice depends on the patient's unique situation and overall health.

Patient Experience

During the procedure, patients will typically feel no pain due to effective anesthesia but might experience pressure or movement. After the procedure, discomfort, swelling, and limited jaw mobility are common but manageable with prescribed pain relief. Post-procedure care will focus on minimizing discomfort and ensuring proper healing, with most patients returning to normal activities within a few days to a week.