We take a standard set of additional steps to make more complicated extractions easier. As noted above, we first pull back the gums and remove any bone above the wisdom tooths. Next, we drill a slot in the tooth to make space for our elevator. Then we apply pressure to loosen the tooth and determine if we need to take additional steps. Finally, with the tooth slightly loosened, we drill a slot or trough around the bone on the cheek and back side around the tooth. This slot will give the tooth space to move and loosen.
If drilling a trough around the tooth is not enough, we then drill the tooth in half so we can remove the roots separately. As stated earlier, the roots sometimes want to rotate into the other half. Therefore, each half of the tooth will block the other from coming out. To avoid this, we move on to cutting off the tooth's crown, giving space to the other half to rotate out.
If the wisdom tooth still does not come out, there is usually a ledge in the bone, a bulbous root, or an extremely curved root impeding the extraction. In this case, the dentist will smooth out any interfering bone until the tooth comes out of the socket.