Surgical extractions: Sectioning multi-rooted teeth.

Sectioning a tooth into parts during the extraction process may be a fairly routine affair.

The degree of complexity associated with sectioning and extracting a tooth can vary widely. The planned sectioning of a lower molar can be a straightforward and relatively quick affair. On the other hand, sectioning and removing an impacted lower wisdom tooth that is deeply buried within the patient's jawbone can be expected to be an entirely different matter.

In most cases, when a challenging impacted wisdom tooth is removed the patient is sedated and therefore oblivious to the dentist's activities. In comparison, with the routine sectioning of an erupted tooth the patient will likely be conscious. If so, they may be curious as to what is taking place.

For these patients we offer the following description of the routine sectioning and extraction of an erupted lower molar. This is just one scenario by which this process could take place. The precise technique and protocol used with particular patient's tooth will vary dentist by dentist, due to differences in their training and clinical experiences.

Extracting a lower molar using a tooth-sectioning technique.

A) The dentist will numb the patient's tooth.

The dentist will use a local anesthetic ("novocaine") to numb up the patient's tooth and surrounding gum tissue, just the same as they would for any tooth extraction.

B)The dentist will start the extraction process using a dental elevator.

The dentist will first start to loosen up the tooth with an "elevator." This a lever-type extraction instrument that is wedged and worked between the tooth and its surrounding bone tissue. The dentist will work with the elevator at different locations around the tooth, taking advantage of any loosening effect that it can create. You, the numb patient, will feel the pressure created by the elevator's action but no pain.

C) The dentist will continue the extraction process using extraction forceps.

Although the dentist has reason to expect that the tooth will need to be sectioned before it can be removed (possibly due to something they have observed when reading the tooth's x-ray), at this point there's no reason why they shouldn't go ahead an try to remove the tooth conventionally using a pair of extraction forceps ("dental pliers").

If the tooth comes out, great. If it proves to be stubborn, the forceps' action should at least provide some additional loosening effect. Just as with the use of the dental elevator, you will feel the pressure that the dentist applies to your tooth with the forceps (as they rock and twist the tooth back and forth) but you should feel no pain.

D) The dentist will section the tooth.

At this point in the extraction process the dentist will be ready to section the tooth. Teeth are typically sectioned using a dental drill (handpiece). The dentist may have a special handpiece designed specifically for this task. Or they may use one of their standard dental drills.

The location the dentist chooses for the sectioning process will be influenced by a number of different considerations. In general the dentist is trying to create smaller, yet still manageable, tooth sections that on their own can be removed more easily and predictably than the tooth as a whole. In the case of a two-rooted lower molar, the logical place to section the tooth is in half, right between its two roots.

The dentist will want to perform the tooth sectioning process in the presence of a copious amount of irrigation (water or saline). This irrigant might come from their dental drill or else the dentist's assistant may dispense it. Irrigating the work field (and suctioning away the excess fluids) will flush away blood and debris, therefore helping to provide a clear view for the dentist as they work. Just as important, it will also help to minimize the amount of bone traumatizing heat that the drilling process creates.

You might anticipate that the dentist's drilling through the tooth (including through its nerve tissue) might be painful. Since they have already numbed up your tooth, it won't be. You will feel the vibrations of the drilling process but otherwise it should be a non-event.

E) The dentist will remove the sectioned tooth pieces.

After the dentist has completed the drilling process the individual tooth sections may or may not be completely separate. As a check, and to finish the job if they're not already apart, the dentist will place their dental elevator in the drilled groove between the planned sections and give a slight twist. If the sections are already separate, the dentist will see each tooth piece move. If they are not yet separate, you might hear a faint snap as the elevator's pressure breaks them apart. Or, if the dentist feels they have already applied enough pressure yet the sections haven't separated, they will drill some more and then try with the elevator again.

At this point the individual tooth pieces can be removed. The dentist will return to their conventional extraction instruments and manipulate (wedge, twist, turn, and rock back and forth) these individual sections until each has loosened up enough to come out. Any loosening effect that the dentist was able to accomplish prior to sectioning the tooth will make this part of the extraction that much easier.

Sometimes the individual tooth sections, collectively, will have an interlocking nature. If so, after the "keystone" section is discovered and removed the other section(s) may come out more readily. Also, as each tooth section is removed additional workspace is gained, thus providing the dentist with greater access to the tooth parts that still remain. Once all of the individual tooth pieces have been removed, the dentist will wrap up the patient's extraction procedure just as they would with any extraction.

[ Related pages: Aftercare - The first 24 hours following a tooth extraction. >> ]
[ Related pages: Aftercare during the time period beginning 24 hours after a tooth extraction. >> ]

Stitches may not be needed.

Sectioning a tooth in a fashion as we have described here typically will not disturb the tooth's surrounding gum tissue to any greater extent than a conventional extraction would. If this is the case, the dentist won't need to place any sutures (stitches).

What kind of postoperative pain and/or swelling should you expect after tooth sectioning?

You don't have to expect that a tooth extraction involving tooth sectioning will necessarily be followed by any more pain or swelling than a conventional extraction, but it certainly may. It will all have to do with the amount of tissue trauma that has taken place during the procedure. We will say that in some cases tooth sectioning can result in less overall tissue trauma than a poorly planned and executed conventional extraction.

In those cases where the tissues that surrounded the tooth (bone and gum tissue) have been significantly traumatized, the patient will be more likely to experience greater levels of pain and/or swelling. Your dentist won't be able to predict precisely what will take place in your case. But due to their experiences with other patients, they should be able to give you a good idea.