Surgical tooth extraction: what it is, when it is needed, whether it hurts and how it heals

What is surgical tooth extraction?

Dłutowanie zęba is the everyday Polish name for surgical tooth extraction, the removal of a tooth or its root in which, depending on the situation, the dentist cuts the gum, removes part of the surrounding bone or divides the tooth into sections. The name comes from dłuto, the Polish word for a chisel, yet the basket of services funded by the NFZ, Poland’s National Health Fund, describes the procedure as removal of a tooth “using drills and elevators”, and oral surgery also uses piezosurgical devices.

The NFZ basket distinguishes two kinds of surgical extraction. “Surgical removal of a tooth” covers intra-alveolar work, meaning drills and elevators used within the tooth socket, while “removal of a tooth by extra-alveolar bone removal with a mucoperiosteal flap” requires lifting the gum together with the periosteum to expose the bone (Ministry of Health regulation, consolidated text Dz.U. 2025 poz. 615).

General principles of tooth removal, including simple extraction, are covered in the article on tooth extraction, and the reasons for removing wisdom teeth in the article on wisdom tooth removal. Here we focus on the surgical procedure itself: how it is done, what you feel and what to expect afterwards.

When is surgical tooth extraction needed?

Surgical extraction is needed when a tooth cannot be removed safely with forceps and elevators alone, because it is hidden in the bone, broken off at the gum or has roots whose shape makes an ordinary extraction difficult. Typical situations are:

Whether surgical extraction is needed is decided by the dentist after an examination and an X-ray, usually a panoramic X-ray. When the image suggests close contact between the roots of a lower wisdom tooth and the nerve canal in the lower jaw, the 2019 European EADMFR position statement provides for a CBCT scan, but only when its result could change the surgical plan.

• An impacted tooth, most often a lower wisdom tooth, that remains partly or completely in the bone.
• A tooth broken at or below the gum line that cannot be gripped with forceps.
• A root left in the bone after an earlier extraction or after decay has destroyed the crown.
• A tooth that fractures during an ordinary extraction; the plan then changes during the procedure.
• A tooth with strongly curved or widely spread roots.

How is surgical tooth extraction done, step by step?

Surgical tooth extraction is usually done under local anaesthesia, and the patient goes home the same day. According to the NHS, removing a wisdom tooth often takes a few minutes and should not take longer than 40 minutes; the leaflet from University Hospitals Sussex gives the same range.

The gum is cut, bone removed and the tooth divided only when needed. The surgical procedure usually runs like this:

• Examination, X-ray and medical history: conditions, medicines and allergies.
• Local anaesthesia and a check that it has taken effect.
• Cutting the gum and folding back a flap that exposes the bone over the tooth.
• Removing part of the bone around the crown or roots with a drill, while the area is irrigated.
• Dividing the tooth into 2 or 3 parts and taking them out one by one.
• Cleaning the socket, laying the gum back in place and stitching, usually with dissolvable stitches, which according to British patient leaflets disappear within 2 to 3 weeks.
• Biting on a gauze pad and going through the advice for the first few days.

Does surgical tooth extraction hurt?

The surgical extraction itself should not hurt, because it is done under local anaesthesia. The University Hospitals Sussex leaflet explains that the anaesthetic starts working within a few minutes and means that removing the tooth is not painful; you may feel pressure.

Pain comes once the anaesthetic wears off. According to the same leaflet, discomfort and swelling are usually worst for the first 3 days, soreness can take up to 2 weeks to settle completely, and regular painkillers are usually needed for 3 to 4 days; the dentist chooses the medicine.

After a surgical extraction the jaw is often stiff, and for about a week soft food is easier to eat. A bruise may appear on the skin of the face and fades within 2 weeks. The NHS adds that after wisdom tooth removal most people return to their usual activities the next day.

If the procedure cannot be done under local anaesthesia, for example because of a disability or an allergy to local anaesthetics, the surgical extraction can be carried out under general anaesthesia after assessment by an anaesthetist; this is described in the article on tooth removal under general anaesthesia.

Drill, chisel or piezosurgery: does the method matter?

The way the bone is removed during a surgical extraction mainly affects swelling and the length of the procedure, and the evidence is uncertain. A meta-analysis of randomised trials (Jiang et al., 2015) found that piezosurgery lengthened the procedure by an average of 4.13 minutes but led to less swelling on days 1, 3, 5 and 7; the differences in pain and trismus (restricted mouth opening) were not statistically significant.

A 2020 Cochrane review of 62 studies with 4,643 participants compared different techniques for removing lower wisdom teeth, including a chisel versus a drill in a surgical handpiece. The authors rated the certainty of the evidence as low or very low and wrote that they could not yet give surgeons firm recommendations.

For patients the conclusion is practical: studies do not point to a single technique that is better in every respect. The dentist chooses the instrument to suit the position of the tooth and the surgical plan drawn up from the X-ray.

What complications can occur after surgical tooth extraction?

The most common complication after a surgical extraction is dry socket, a painful inflammation of the socket after the blood clot has been lost. The review by Kolokythas et al. (2010) reports that it occurs about 10 times more often after surgical extractions than after simple ones, and in 1 to 37.5% of cases after removal of lower wisdom teeth.

With lower wisdom teeth there is a risk of injury to the inferior alveolar nerve, which causes numbness of the lower lip and chin. The review by Sarikov and Juodzbalys (2014) gives a frequency of 0.35 to 8.4%; in 96% of cases sensation returns within 4 to 8 weeks, and permanent injury affects 0 to 2% of patients.

When upper back teeth are removed, an opening between the mouth and the maxillary sinus can form. The British Association of Oral Surgeons (BAOS) states that it is closed with a gum flap under local anaesthesia, successfully in 95% of cases.

A 2020 Cochrane review indicates, with low certainty, that platelet-rich plasma or platelet-rich fibrin placed in the socket may reduce the risk of dry socket (odds ratio 0.39). Difficulty breathing, speaking or swallowing, or rapidly increasing swelling of the face and neck, calls for the hospital emergency department (SOR) or the emergency number 112; advice for the following days is in the article on what to do after a tooth extraction.

How does surgical extraction differ from a simple extraction?

The key difference is that in a surgical extraction the dentist also works in the bone, not only in the socket. The table compares the two procedures on the basis of the NFZ basket, NHS hospital leaflets and the Kolokythas review; the times given are typical rather than fixed for every case.

How much does surgical tooth extraction cost, and is it available on the NFZ?

In the DentalBlue clinic’s price list, “Ekstrakcja zęba z dłutowaniem” (extraction with bone removal) costs 550 zł, “Operacyjne usunięcie zęba częściowo zatrzymanego” (surgical removal of a partially impacted tooth) 800 zł and “Operacyjne usunięcie zęba całkowicie zatrzymanego” (surgical removal of a fully impacted tooth) 1 000 zł. “Badanie/konsultacja” (examination and consultation) in the surgery category costs 300 zł, “Pantomogram” (panoramic X-ray) 120 zł and “Tomografia komputerowa- szczęka lub żuchwa” (CBCT scan, upper or lower jaw) 300 zł. The final scope and cost are set by the dentist at the consultation, and prices may change.

Surgical extraction is funded by the NFZ: the basket for adults includes “surgical removal of a tooth”, and the list of oral surgery services also includes extra-alveolar extraction with a flap and surgical removal of an impacted tooth (Ministry of Health regulation, consolidated text Dz.U. 2025 poz. 615). Local anaesthesia is a separate item in the basket, and no referral is needed to see a dentist (art. 57 ust. 2 pkt 2 of the Act on publicly funded healthcare services; legal status as of 24 October 2026).

How surgical tooth extraction works at DentalBlue

DentalBlue in Białystok carries out extractions, from routine to complex procedures, under local or general anaesthesia. Panoramic X-rays and CBCT scans are taken by the clinic’s own radiology unit, so the image needed to plan a surgical extraction is made on site. General anaesthesia is available for children who cannot cooperate in the chair, patients with a disability, people allergic to local anaesthesia and for inflammation too acute for local anaesthesia to work; it starts with a combined dental and anaesthesiology consultation. The clinic also offers inhalation sedation with nitrous oxide. A “Wizyta z bólem” (visit in pain) includes a panoramic X-ray, a consultation, an examination and pain relief.