Removal of retained, atypically located teeth of category I

A malpositioned tooth has erupted in the wrong place or is tilted or rotated. A partially impacted tooth has only partly emerged from the gum. Such teeth cannot be removed with ordinary forceps: a surgical extraction is needed, with a gum incision and, if necessary, sectioning of the tooth. Category I covers relatively simple cases: the tooth lies shallow and away from the nerve and sinus. At UKRMED Maxillofacial Surgery, these procedures are performed by surgeon Anna Kravchenko.

What surgical extraction means

A routine extraction loosens the tooth with forceps and removes it through the socket. A surgical approach is needed when the tooth:

• is partly covered by gum or bone;
• has erupted at an angle or horizontally;
• has curved, divergent or fused roots;
• sits outside the dental arch.

The gum is opened and, if needed, a thin layer of bone is removed.

What category I means

• the tooth is partly erupted or lies shallow;
• the roots are not close to the mandibular nerve or maxillary sinus;
• access to the tooth is relatively simple.

Deeply impacted teeth, teeth near the nerve or sinus, and teeth fully buried in bone fall under category II.

When removal is needed

• repeated gum inflammation over a partly erupted wisdom tooth (pericoronitis);
• decay in the tooth or its neighbour that cannot be treated;
• a malpositioned tooth injuring the cheek or tongue;
• a tooth blocking orthodontic treatment;
• supernumerary teeth.

The UK's NICE advises against prophylactic removal of impacted wisdom teeth that cause no problems, so removal is decided by indication.

Diagnosis

A periapical X-ray or OPG shows the tooth position, root shape and distance to the nerve and sinus. If lower roots are close to the nerve canal, a CT is ordered — a 2026 systematic review confirms that proximity to the canal is the main factor in nerve injury risk.

The procedure

1. Local anaesthesia or sedation.
2. Gum incision and flap.
3. If needed, a small bone window with a piezosurgical instrument.
4. Removal of the tooth whole or in sections.
5. Socket care and stitches.

The procedure takes 20–40 minutes.

Recovery

Swelling and moderate pain last two to three days. Apply cold to the cheek, eat soft food, avoid rinsing on the first day and do not smoke. Stitches are removed after 7–10 days. Complications such as dry socket are covered on the tooth extraction page.

Risks and complications

• Dry socket — severe pain on days two to four when the clot is lost from the socket. It is treated at the clinic in one or two visits.
• Bleeding — slight oozing on the first day is normal; if bleeding does not stop after pressing gauze for 20–30 minutes, call the surgeon.
• Lip or tongue numbness — rare in category I, as the tooth is far from the nerve; usually temporary.
• Sinus communication — when upper teeth with roots near the sinus floor are removed. It is closed straight away; see sinus surgery.
• Damage to the neighbouring tooth — rare, when the tooth presses against the next root.

When extraction is postponed

• acute inflammation with swelling and fever — the inflammation is treated first;
• anticoagulants — never stop them yourself; the plan is agreed with your doctor;
• bisphosphonate treatment or radiotherapy to the jaws — a special approach is needed;
• pregnancy — planned extraction is postponed; urgent extraction is done with safe anaesthesia.

Prices at UKRMED

Sources

1. National Institute for Health and Care Excellence (NICE). Guidance on the extraction of wisdom teeth (TA1). https://www.nice.org.uk/guidance/ta1
2. Raj K., Arulrasan S. G., Murugesan K. et al. Anatomical Risk Factors Associated with Inferior Alveolar Nerve Injury During Third Molar Surgery: A Systematic Review. J Maxillofac Oral Surg, 2026. https://doi.org/10.1007/s12663-025-02582-5