Dental Surgery Munich | Dentist Christina Dickel

Not every wisdom tooth needs to be removed. However, removal is indicated when:

• Lack of space (retention/impaction): The wisdom tooth does not have enough room to fully erupt. It remains trapped in the bone or beneath the gum and can exert pressure on neighboring teeth, leading to tooth displacement and crowding.
• Recurrent inflammation (pericoronitis): With partially erupted wisdom teeth, a gum flap often forms over the chewing surface where bacteria accumulate. The result is painful, recurrent inflammation of the surrounding soft tissue.
• Cavities and damage to neighboring teeth: Displaced wisdom teeth are difficult to clean and frequently develop cavities. Particularly problematic: the contact pressure can also damage the adjacent second molar — potentially causing root resorption.
• Cyst formation: A follicular cyst can form around the tooth germ of an unerupted wisdom tooth, destroying the jawbone.
• Orthodontic indication: Before or after orthodontic treatment, to prevent renewed crowding of the teeth.

The complexity of wisdom tooth removal depends significantly on the position of the tooth:

Partially retained wisdom teeth have already partially broken through the gum. They are usually easier to remove surgically but more frequently cause inflammation, as the gum flap serves as an entry point for bacteria.

Fully impacted wisdom teeth lie completely hidden within the jawbone and require a more extensive surgical approach. The gum is folded back, bone is removed if necessary (osteotomy), and in some cases the tooth is divided (tooth sectioning/odontosection) to remove it gently and in pieces.

CBCT planning is essential: Particularly with lower jaw wisdom teeth, the inferior alveolar nerve is frequently located in close proximity to the root tips. This nerve provides sensation to the lower lip and chin. Using CBCT 3D diagnostics, we can determine the exact course of the nerve in relation to the roots and plan the procedure to minimize the risk of nerve damage.

Whether all four wisdom teeth are removed in one session or in two separate procedures depends on the complexity and your preferences. For uncomplicated findings and under twilight sedation or general anesthesia, removing all four teeth in one session is possible and advisable — you only have one healing phase instead of two. For complicated positions or if you prefer the procedure under local anesthesia, we often recommend a side-by-side approach (first the right side, then the left, or vice versa), so you can at least chew on one side during healing.

Typical indications for a surgical tooth extraction include:

• Deeply fractured teeth: When the tooth crown has broken off and the root remains in the bone, a simple extraction can no longer be performed.
• Root remnants after failed extraction: Broken root tips that remain in the bone must be surgically removed.
• Ankylosed (fused) teeth: Teeth that have fused with the jawbone and cannot be loosened.
• Supernumerary teeth: Additional teeth that are embedded in the bone and obstruct other teeth.

During surgical tooth extraction, we use piezosurgery whenever possible — an ultrasound-based technique that cuts bone precisely while preserving soft tissue (nerves, gums, mucosa). The result: less swelling, less pain, and faster healing.

After extraction, a bone graft (socket preservation) is often advisable to preserve the jawbone for a future implant and minimize bone loss after removal.

An apicoectomy is a tooth-preserving surgical procedure in which the inflamed root tip and surrounding diseased tissue are removed. It is used when a chronic infection at the root tip (apical periodontitis) does not heal despite root canal treatment, or when a revision of the root canal treatment is not possible.

Indications for an apicoectomy:

• Persistent periapical lesion (granuloma or cyst at the root tip) despite adequate root canal treatment
• Root canal instrument fractured in the canal making revision impossible
• Anatomically complex root canal configurations (severe curvature, canal branches) that prevent complete preparation
• Post-and-core restored teeth where revision would destroy the post and thus the crown

Procedure of an apicoectomy: After local anesthesia, the gum over the affected root tip is folded back. The inflamed root tip is removed together with the diseased tissue (approximately 3 mm). The root canal is then sealed from the tip with a biocompatible material (e.g., MTA — Mineral Trioxide Aggregate) to create a tight retrograde filling. The mucosal flap is sutured, and the bone regenerates over the following months. The procedure typically takes 30-60 minutes per tooth.

The apicoectomy has a success rate of approximately 85-95% and is often the last option to save a tooth before extraction and a dental implant become necessary.

The causes of gum recession are varied:

• Aggressive tooth brushing: Hard toothbrushes and horizontal scrubbing motions with too much pressure are the most common cause of recession — especially on the outer surfaces of canines and premolars.
• Periodontitis: Chronic bacterial gum inflammation destroys the gums and underlying jawbone, leading to significant gum recession.
• Thin biotype: Some people naturally have very thin, delicate gum tissue that is more susceptible to recession than thicker, more robust tissue.
• Malocclusion and malpositioning: Teeth that are positioned outside the dental arch often have a thin bony wall on the outer side, which promotes recession.
• Piercing: Lip or tongue piercings can cause recession through mechanical friction against the gums.

Several proven microsurgical techniques are available for recession repair:

Tunnel technique: A particularly gentle and minimally invasive method in which the gum is not cut open but undermined in a tunnel shape. A connective tissue graft (harvested from the palate) or a collagen matrix is inserted through this tunnel and positioned over the exposed root. Advantage: no visible incisions, faster healing, excellent aesthetic results.

Connective tissue graft (CTG): Considered the gold standard in recession repair. A piece of connective tissue is harvested from the palate and transplanted beneath the existing gum over the exposed root. The graft integrates and permanently thickens the gum — both in height and in thickness.

Guided tissue regeneration (GTR): For pronounced recessions with bone loss, a collagen membrane and/or enamel matrix proteins (Emdogain) can be used to specifically guide the regeneration of gum tissue, bone, and root cementum.

As a general rule: the earlier a recession is treated, the better the results. Recession repair is advisable for:

• Aesthetic concerns: Visible long tooth necks in the front tooth area disturb many patients considerably.
• Hypersensitivity: Exposed tooth necks often react painfully to cold, heat, and sweet foods.
• Root caries risk: The exposed root surface is softer than tooth enamel and significantly more susceptible to caries.
• Progressive tissue loss: Without treatment, the recession can continue to progress and ultimately compromise tooth stability.

Important: Before recession repair, the underlying cause must be eliminated. For aggressive brushing, brushing techniques are modified; for periodontitis, the inflammation must first be brought under control.

Unlike a dental implant, which is made of titanium or ceramic and rigidly anchored in the bone (osseointegration), a transplanted tooth retains its natural periodontal ligament (PDL) — the fibers that elastically suspend the tooth in the bone. This offers crucial advantages:

• Natural sensation: The transplanted tooth has tactile feedback (proprioception) — you can feel how much force you are applying when chewing. An implant does not have this sensation.
• Biological adaptation: The tooth can move slightly and adapts to natural changes — ideal for young patients whose jaws are still growing.
• Bone preservation: The periodontal ligament stimulates the jawbone and prevents the bone loss that is typical with tooth gaps.
• No foreign materials: Since it involves your own tissue, there are no rejection reactions and no peri-implantitis.

Tooth transplantation is an option in certain situations:

• First molar not salvageable, wisdom tooth available: The most common case — a destroyed or fractured first molar is removed and replaced with a healthy wisdom tooth.
• Young patient with tooth loss: In adolescents and young adults whose jaws are still growing, an implant is contraindicated. Tooth transplantation bridges this phase biologically.
• Tooth loss due to trauma: After an accident with tooth loss, a wisdom tooth can be transplanted as a replacement.
• Premolar transplantation for orthodontic crowding: Surplus premolars can be transplanted into gaps at other locations.

Prerequisites: The donor tooth must be of suitable size and shape to fit the recipient site. Ideally, the root development of the donor tooth is not yet fully complete (2/3 to 3/4 root length), as the chances of successful integration are particularly high then. However, teeth with fully developed roots can also be successfully transplanted.

The success rate of tooth transplantation is 80-95%, depending on age, root development, and initial situation. In young patients with still-open root tips, results are particularly good — the transplanted tooth can even continue to gain root length and remain vital (without root canal treatment). For teeth with completed root growth, root canal treatment after transplantation is usually necessary.

Studies show that successfully transplanted teeth can function for decades — with a natural appearance, normal chewing sensation, and healthy periodontal attachment. CBCT-based 3D planning plays a central role here as well: we can digitally compare the size ratios of the donor tooth and recipient site in advance and plan the procedure precisely.

It all begins with a thorough clinical examination and — for most surgical procedures — a CBCT scan (Cone Beam Computed Tomography). The three-dimensional imaging provides us with a detailed picture of the bone and tooth structures, nerve pathways, and soft tissues. On this basis, we can plan the procedure down to the millimeter and identify potential risks in advance.

Examples: For wisdom teeth, the CBCT shows the exact relationship of the roots to the inferior alveolar nerve. For an apicoectomy, we can see the extent of the periapical lesion in all three planes. For tooth transplantation, we can check in advance whether the donor tooth fits the recipient site.

Based on the diagnostic data, we create an individualized treatment plan, which we discuss with you in a detailed consultation. You will learn exactly what happens during the procedure, what alternatives exist, what costs to expect, and what the healing process looks like. We prepare a cost estimate for your insurance and answer all your questions — transparently and without time pressure.

Every surgical procedure is performed under at least local anesthesia — you are completely pain-free during the operation. In addition, we offer graduated sedation options for anxious patients and extensive procedures:

• Nitrous oxide sedation: Gentle relaxation through inhalation of nitrous oxide via a nasal mask. You remain fully conscious but feel relaxed and anxiety-free. Ideal for minor procedures and patients with mild dental anxiety.
• Twilight sedation: A sedative is administered through an IV line. You drift into a sleep-like state but remain responsive. You will have little or no memory of the procedure afterward. Ideal for wisdom tooth surgery and medium procedures.
• General anesthesia: On our anesthesia days, the anesthesia is administered by an experienced specialist anesthesiologist. You sleep throughout the entire procedure and only wake up when everything is over. Ideal for extensive procedures (e.g., removal of all four wisdom teeth), severe dental anxiety, or the desire for complete unconsciousness.

The procedure itself is performed according to the previously discussed plan. We work with modern surgical instruments, including piezosurgery and the finest suture material, to treat the tissue as gently as possible. The operating time varies depending on the procedure: a simple wisdom tooth removal takes approximately 15-30 minutes, an apicoectomy approximately 30-60 minutes, a recession repair approximately 60-90 minutes, and a tooth transplantation approximately 60-120 minutes.

Careful aftercare is crucial for successful healing. After the procedure, you will receive a detailed aftercare plan with all important behavioral guidelines:

• First 24-48 hours: Cool from the outside (10 minutes cooling, 10 minutes pause), soft foods, physical rest, sleep with your upper body slightly elevated. Take pain medication as prescribed — ideally before the anesthesia wears off.
• First week: Swelling peaks on days 2-3 and then subsides. No sports, no smoking, no alcohol, chlorhexidine mouth rinse as directed.
• Suture removal: After approximately 7-10 days at the practice.
• Follow-up appointments: Regular follow-up checks to assess wound healing. For apicoectomies and tooth transplantations, X-ray checks are performed at 3, 6, and 12 months.

Emergency contact: In case of severe pain, post-operative bleeding, fever, or other abnormalities, we are available for you even outside office hours.

The GKV covers the following surgical procedures as part of contractual dental care:

• Wisdom tooth removal: Fully covered by the GKV when there is a medical indication (lack of space, inflammation, damage to neighboring teeth). Out-of-pocket costs only apply to optional services such as sedation or bone graft material.
• Surgical tooth extractions: Also covered by insurance when the tooth must be removed for medical reasons.
• Apicoectomy (WSR): Generally covered by insurance — the GKV covers the surgical procedure. However, premium techniques such as retrograde filling with MTA, microsurgical instruments, or CBCT planning are not covered. These additional services are billed according to the GOZ (German fee schedule for dentists).

Not covered by the GKV:

• Recession repair: Purely private service — treatment of gum recession is not included in the GKV service catalog.
• Tooth transplantation: Also a purely private service, as it is a specialized procedure not included in the GKV service catalog.
• Sedation and anesthesia: Nitrous oxide, twilight sedation, and general anesthesia are generally private services — with exceptions for certain indications (e.g., very young children, disability, documented dental phobia).

Private insurers reimburse surgical procedures depending on the plan — often more comprehensively than the GKV. Many PKV plans also cover recession repair, tooth transplantation, and sedation costs. However, reimbursement varies greatly depending on the insurance contract. We recommend submitting a treatment and cost plan to your PKV before the procedure. We will of course prepare this for you.

For procedures with out-of-pocket costs or purely private services, we offer flexible installment payment plans. Optimal treatment should not fail due to financing — please ask us about this during the consultation.