Impacted tooth extraction is a surgical procedure performed when a tooth cannot erupt normally into the oral cavity and causes problems under the bone or gum tissue. The first step is a detailed examination and imaging. A panoramic X-ray is used to evaluate the position of the tooth, the root morphology, and its relationship with adjacent structures (such as the inferior alveolar nerve in the lower jaw and the maxillary sinus in the upper jaw). If the radiograph shows close contact with the nerve, curved roots, deep impaction, or an abnormal position, your dentist may request CBCT (cone-beam CT) for three-dimensional assessment.
After planning is completed, local anesthesia is administered to numb the area. The surgeon makes a small incision in the gum to expose the tooth; if necessary, a limited amount of bone removal (osteotomy) is performed to reveal the crown or roots. Depending on the level of impaction, the tooth may be sectioned into smaller pieces (crown/root separation) to minimize trauma. The site is irrigated thoroughly, sharp bone edges are smoothed, and the area is closed using absorbable or non-absorbable sutures. Cold application and prescribed medications help increase comfort after the procedure, and the surgeon provides personalized postoperative instructions.
When Is Impacted Tooth Extraction Necessary?
Extraction is not “routine”; it is based on clinical and radiographic findings. Surgery is medically indicated in cases such as: recurrent or severe pericoronitis (inflammation of tissue covering a partially erupted tooth), caries or periodontal bone loss on the adjacent second molar, resorption of the neighboring tooth root, cysts/tumors, prevention of second-molar eruption, or interference with orthodontic/orthognathic or prosthetic planning. Pain, chewing limitation, difficulty opening the mouth, and recurrent swelling are also strong indicators for extraction.
However, asymptomatic impacted teeth that remain stable in the bone and show no pathology are not extracted “just in case” in modern clinical practice. In such cases, periodic monitoring is preferable based on a risk-benefit evaluation. The decision is made by combining clinical examination with radiographic evidence.
What Preparations Are Made Before Impacted Tooth Extraction?
A detailed medical history is taken, including systemic diseases (e.g., uncontrolled diabetes), pregnancy, use of blood thinners/anticoagulants, drug allergies, past infections, and jaw joint problems. If necessary, your dentist may request consultation with other physicians. If there is an active oral infection, it is treated first; scaling and plaque removal improve surgical site hygiene.
Patient education is an essential part of the process: surgical steps, expected swelling/tenderness, potential complications (dry socket, infection, nerve injury, sinus communication, etc.), and healing time are explained. Sedation options may be considered for anxious patients. Before the appointment, instructions are given regarding diet, restrictions on smoking/alcohol, and management of current medications.
Which Techniques Are Used in Impacted Tooth Extraction?
The technique depends on the tooth’s position and complexity. Common approaches include:
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Surgical extraction under local anesthesia: Sufficient for most cases. A triangular or envelope flap may be created, limited bone removal is performed, and the tooth is sectioned when needed to minimize trauma.
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Surgical extraction with sedation: Used for highly anxious patients or multiple/complex cases, performed under the supervision of an anesthesia specialist.
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General anesthesia (rare): Reserved for special situations such as multiple impacted teeth requiring removal in one session, airway management concerns, or lack of patient cooperation.
The goal is to remove the tooth with minimal trauma to surrounding bone, neighboring teeth, and soft tissues, using adequate irrigation and gentle elevation. Close proximity to the sinus (upper molars) or the inferior alveolar/lingual nerve (lower molars) requires special attention.
How Long Does Impacted Tooth Extraction Take?
Duration depends on depth of impaction, angulation (mesioangular, horizontal, distoangular, vertical), number/shape of roots, bone density, proximity to nerves or sinuses, and mouth opening. Simple partially impacted teeth may be removed in 15–30 minutes, while deeper or multi-rooted teeth may take 45–60 minutes or longer. A longer procedure does not indicate a problem—safety and control are the priority.
Is Impacted Tooth Extraction Painful?
No pain is expected during the procedure because the area is completely numbed with local anesthesia. You may feel pressure or movement, but not pain. Mild-to-moderate discomfort, swelling, and limited jaw opening during the first 24–72 hours are normal and typically managed with prescribed analgesics and cold compresses. Increasing pain, foul odor/taste, or loss of the blood clot may indicate “dry socket,” and your dentist should be contacted.
Postoperative Care After Impacted Tooth Extraction
Healing depends greatly on care during the first 48–72 hours:
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Bleeding control: Bite firmly on the gauze for the recommended time; avoid spitting, using straws, or vigorous rinsing.
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Cold application: Intermittent ice packs during the first 24 hours reduce swelling and discomfort.
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Diet: Start with soft/room-temperature foods; avoid very hot/cold or hard foods. Drink plenty of water; avoid alcohol and smoking (at least 48–72 hours, preferably longer).
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Oral hygiene: Avoid brushing the surgical area on the first day; after 24 hours, gentle brushing and prescribed antiseptic/saline rinses may be used. If sutures are not absorbable, they are usually removed after 7–10 days.
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Medications: Take antibiotics/analgesics/anti-inflammatory drugs exactly as prescribed.
Contact your dentist if you experience persistent or worsening pain, uncontrolled bleeding, fever above 38°C, foul discharge, increasing swelling, prolonged numbness of the lip/tongue/chin, or difficulty breathing/swallowing.
How Long Is the Healing Period After Impacted Tooth Extraction?
Swelling peaks in the first 24–72 hours, then gradually decreases. Soft tissue generally heals within 7–14 days. Chewing comfort improves significantly within a few days to one week. Bone remodeling takes longer: filling of the extraction site occurs over 6–12 weeks, and complete bone maturation takes 3–6 months. If temporary nerve numbness occurs, it usually improves over weeks to months with proper follow-up.
This page is for informational purposes only.
For diagnosis and treatment, you must consult your dentist.