Removing complex teeth safely and with minimal impact.
Key Steps
Surgical extractions follow a structured process with four key phases: soft tissue surgery, hard tissue surgery, tooth extraction and closure. These phases ensure access and safeguard the surrounding structures during the procedure. We start by creating a soft tissue flap to expose the hard tissues around the tooth, which provides the necessary visibility for the subsequent phases.
After manipulating the soft tissue, we proceed with hard tissue surgery using high-speed dental drills to remove the bone around the tooth roots. By reducing the bone, we decrease the roots’ attachment, simplifying the extraction. Next, we extract the tooth with minimal trauma and suture the surgical site for optimal healing. Below, you will find a detailed explanation of each phase.
Soft Tissue Surgery
To perform a surgical extraction, we start by creating soft tissue flaps to remove gingival and mucosal tissue from the site. Adequate blood supply is crucial as a poorly perfused flap can necrose and jeopardise the procedure. To ensure proper circulation, we make divergent cuts with the flap’s base wider than the top, targeting the mesial and distal interproximal spaces of the tooth. Full-thickness cuts through the gingiva, mucosa and periosteum over bone that will remain post-surgery and help keep the suture line stable.
After making the cuts, we use a periosteal elevator to lift the flap, exposing the underlying bone. Handling the flap carefully is crucial, especially in cats, due to their delicate tissue. We also trim the gingival margin around the alveolus to create a bleeding edge, which enhances healing when the tissue is closed.
Hard Tissue Surgery
Hard tissue surgery focuses on removing the bone around the tooth roots to achieve two goals: detaching the tooth from the bone and separating the surrounding bone from the skull or mandible. Using radiographs and anatomical knowledge, we locate the root’s shape and position, with particular attention to the buccal/labial bone plate and the mesial and distal root edges.
We use a high-speed drill with a bur to make cuts along the root borders from the crestal bone toward the soft tissue flap. These cuts form a “U” shape, detaching the buccal/labial bone plate and reducing the root’s attachment. It’s crucial to avoid excessive damage to the root to prevent it from becoming brittle and difficult to remove. Once complete, we extract the roots individually, sectioning multi-rooted teeth into pieces if needed.
Extraction & Closure
The actual extraction with dental elevators and forceps follows sufficient bone removal. We section multi-rooted teeth into individual fragments for easier removal, taking special care to reduce trauma throughout the process.
After extraction, we replace the soft tissue over the deficit. Tension is the most crucial factor as any closure done under tension will fail. To avoid this, we release the periosteum beneath the flap with a scalpel while holding it under slight tension. This increases flap mobility, so we take extreme care to avoid cutting through it. Once the flap is sufficiently released, we close it with absorbable sutures, typically 4-0 size with a reverse cutting needle, ensuring the suture passes through the gingiva easily, reducing tearing risk and promoting optimal healing.
