Chiselling — in Polish dłutowanie — is one of the few terms in dentistry that unsettles patients more than the procedure it describes. It is usually mentioned while a panoramic radiograph is being reviewed, as shorthand for why a wisdom tooth cannot simply be lifted out. The reaction is predictable: the question is no longer how the procedure is performed, but whether it can be avoided.
In reality, chiselling is a historical name that has outlived the instrument it came from by a considerable margin. The modern procedure is something else entirely: a small window is prepared in the bone with a precision bur cooled by sterile saline, and the tooth is divided into fragments so that it can be removed through a smaller opening. The paradox worth understanding before the appointment is this: dividing a tooth into parts is a less invasive procedure than removing it whole.
This article takes you through the procedure step by step: what happens, what the patient feels, how long it takes and where the risk actually lies. It assumes that the decision to extract has already been made. If it has not, the starting point is our comprehensive guide to wisdom tooth extraction.
Key takeaways
- Chiselling is a historical name: today the bone is prepared with a bur cooled by sterile saline, not with a chisel and mallet.
- The tooth is divided into fragments in order to remove less bone — which is precisely why it is less invasive than removing the tooth whole.
- The procedure itself takes from about 20 to 90 minutes depending on its difficulty; allow one to two hours for the whole appointment.
- With effective anaesthesia you feel pressure, vibration and sound, but not pain.
- The risk of altered sensation concerns lower wisdom teeth above all and is transient in most cases; planning begins with a radiograph.
Where the name came from and what lies behind it today
The term dates from a period when the bone of the alveolar ridge was prepared with a surgical chisel and mallet. Those instruments left everyday practice decades ago, but the name remained — and it is the name, rather than the procedure, that may now generate anxiety.
In practice, contemporary chiselling means three actions carried out in a defined order. The first is exposure of the operative field: an incision and reflection of a portion of the gum to gain access to the tooth. The second is ostectomy (the controlled removal of the thin layer of bone covering the crown). The third is tooth sectioning (dividing the tooth into fragments with a bur), thanks to which the crown and the roots come out separately, through an opening considerably smaller than the outline of the whole tooth.
The change of instrument is not cosmetic. In a prospective study of 705 patients following removal of lower wisdom teeth, altered sensation occurred markedly more often in those procedures in which a chisel was used — it affected more than 6 in 100 such patients, that is, more than ten times more often than with the remaining techniques. This is one of the reasons the chisel was abandoned: a bur allows work over a smaller area and transmits less shock to the surrounding tissues.
When simple extraction is not enough — indications for surgical extraction
Simple extraction is possible when the crown of the tooth is accessible and the roots are of a predictable shape that allows the tooth to be removed in one piece. Wisdom teeth rarely meet both of these conditions at once. They tend to be tilted, partly covered by bone or gum, with divergent or curved roots, and the space available in the arch is whatever is left — which is usually very little.
| Dimension | Simple extraction | Surgical extraction (chiselling) |
| Indication | Fully erupted tooth, accessible crown, roots of predictable shape | A tooth that has not fully erupted or is covered by bone; divergent or curved roots; limited access |
| Course | Loosening and removal of the whole tooth with hand instruments | Exposure of the field, preparation of a bone window, sectioning of the tooth, removal in parts |
| Duration | Usually 15–20 minutes | From about 20 to 90 minutes, depending on difficulty |
| Sutures | Usually not required | Placed as standard |
| Healing | Symptoms mild, usually resolving within two to three days | Swelling and limited mouth opening usually greatest on the second and third day, then gradually subsiding |
The boundary between the two is not sharp and cannot always be established before the procedure. It happens that an extraction planned as simple requires the roots to be divided during surgery — and conversely, a tooth that looks alarming on the radiograph comes out without much resistance. This is why the clinician usually mentions both scenarios rather than promising one. Both fall within the scope of surgical tooth extraction and differ in technique, not in purpose.
Surgical wisdom tooth extraction step by step — the seven stages
The table below describes the typical course of surgical removal of a lower wisdom tooth. The right-hand column answers the question patients ask most often: what does it feel like at that moment.
| Stage | What the clinician does | What the patient feels at this stage |
| 1. Anaesthesia | Administration of local anaesthesia and waiting for it to take effect | A sting, then a spreading sensation of warmth and increasing numbness of the lip, chin and tongue |
| 2. Exposure of the field | Incision and reflection of a portion of the gum to gain access to the tooth and bone | Pressure and slight tension in the tissues, without pain |
| 3. Preparation of the bone window | Removal of the thin layer of bone over the crown with a bur cooled by sterile saline | The sound of the bur, vibration transmitted through the mandible, a sensation of coolness from the irrigating fluid |
| 4. Sectioning of the tooth | Cutting the tooth into fragments — the crown separately, the roots separately | Short bursts of vibration, sometimes a distinct crack as the tooth separates |
| 5. Removal of the fragments | Removal of the successive parts of the tooth with hand instruments | Firm pressure and rocking, a tugging sensation in the mandible |
| 6. Cleaning of the socket Removal of residual tissue, smoothing of the bone margins, irrigation of the wound Pressure, coolness and the sensation of fluid flowing in | Removal of residual tissue, smoothing of the bone margins, irrigation of the wound | Pressure, coolness and the sensation of fluid flowing in |
| 7. Closure of the wound | Approximation of the gum margins with sutures; sutures are usually removed after 7–10 days | Gentle traction on the gum and a feeling of tension |
For someone who is apprehensive about the procedure, one theme in this table matters most: with effective anaesthesia the patient perceives pressure, vibration and sound, but not pain. These are different kinds of sensation, yet under stress they are easily confused. Sharp, localised pain during the procedure is a signal to tell the clinician so that the anaesthesia can be supplemented — not something to be endured.
In our dental practice at Modern Dental & Orthodontics (Klinika MDO) we observe that the name of the procedure provokes more resistance than the procedure itself — once it has been explained what chiselling involves today, the decision on a date is usually made during the same appointment.
Why dividing the tooth preserves bone
This is the part of surgical extraction that runs most counter to intuition. If the tooth is going to be removed anyway, why cut it first? The answer is geometric.
A tooth locked in bone can be removed whole only if the opening in the bone is at least as wide as the widest outline of the tooth — and with divergent roots this means removing a considerable amount of the surrounding bone. If, however, the crown is separated from the roots and the divergent roots are divided from one another, each fragment can be brought out separately, along its own axis. The opening required for this is distinctly smaller.
The consequences are practical. Less bone removed means a smaller wound, a lower risk of impaired socket healing and a preserved bony wall on the side of the adjacent molar — the same wall that determines whether the second molar retains its support. Sectioning the tooth lengthens the procedure itself by a few minutes, but usually shortens and eases what happens over the following week.
The same logic underlies techniques that limit trauma to bone. In a randomised trial in which one wisdom tooth in the same patient was removed conventionally and the other using piezosurgery, after two days the swelling of the lower face and the limitation of mouth opening were smaller on the side operated on with piezosurgery — at the cost of a longer procedure.
How long the procedure takes, and how long the appointment takes
These are two different figures, and confusing them is the source of most disappointment.
Surgical extraction itself, timed from the start of work in the operative field to placement of the suture, takes from about 20 to 90 minutes. The range depends almost entirely on difficulty. A fully erupted wisdom tooth requiring only division of the roots takes about twenty minutes. One lying deep, with curved roots close to the mandibular canal, may take as long as an hour and a half. Upper wisdom teeth tend to be technically easier, because the bone of the maxilla is less dense.
The appointment lasts longer than the procedure. It also includes discussion of the radiograph and the plan, time for the anaesthesia to take effect, preparation of the field and, once everything is done, the aftercare instructions, the pressure pack and a moment to recover. Allow one to two hours for it and do not plan anything demanding immediately afterwards.
A shorter procedure is not always a better one, and a longer one does not mean that something has gone wrong — sometimes the opposite is true: the clinician divided the tooth into more fragments rather than forcing it out whole. The fee depends on the difficulty of the procedure and is agreed individually; current information can be found in the clinic's fee list.
The inferior alveolar nerve and the maxillary sinus — planning and risk
Two anatomical structures determine how the procedure is planned.
For lower wisdom teeth this is the inferior alveolar nerve (it runs within a canal inside the mandible and supplies sensation to the lip, chin and lower teeth). The roots of a wisdom tooth may lie immediately against the canal and sometimes embrace it. Injury to the nerve presents as numbness or tingling of the lip and chin on the operated side — not as pain and not as muscle weakness. Less frequently the lingual nerve, which runs just inside the lingual wall of the mandible, becomes irritated; half of the tongue then goes numb and the sense of taste weakens — also, as a rule, transiently.
The scale of this risk is small, but not zero. In the study of 705 patients mentioned above, transient altered sensation was found in about 2 in 100 people, and sensation still altered after one year in fewer than 1 in 100. The risk is not, however, evenly distributed. Where imaging showed the tooth compressing the mandibular canal, altered sensation affected more than one third of patients in that small group — an estimate carrying substantial uncertainty. In a meta-analysis covering only patients in higher-risk groups, selected on the basis of tomographic imaging, the pooled risk was close to 10 in 100, and in the most difficult cases about 15 in 100 — with the authors themselves describing the certainty of these estimates as low to very low. Selection is the key point here: these are not figures for the average wisdom tooth, but for those judged difficult from the outset.
Hence the role of diagnostic imaging. A panoramic radiograph shows the position of the tooth and its relationship to the canal in two dimensions. Cone-beam computed tomography (CBCT) adds a third dimension and makes it possible to assess whether a layer of bone remains between the root and the canal. The evidence on what this knowledge changes is not unequivocal, however: in one study severe compression of the canal seen on CBCT was associated with a markedly higher risk and accounted for more than half of all recorded nerve injuries, while in another none of the features visible on CBCT proved to be a useful predictor of altered sensation — although in that same study certain features visible on a plain panoramic radiograph did prove predictive. There is agreement on one point: CBCT is not a routine investigation for every wisdom tooth, but it is warranted where the panoramic radiograph signals close contact. More on the choice of investigations is set out in our guide to dental radiology.
In the most difficult situations, the alternative considered is coronectomy — deliberately leaving the roots in the bone and removing only the crown. Meta-analyses show that the risk of nerve injury is many times lower with this approach than with complete removal, but the benefit is paid for with a different risk: in 3–4 in 100 patients a second intervention is subsequently required, and over follow-up exceeding ten years about 15 in 100 cases required reoperation. It is therefore not a default solution, but a choice reserved for particular anatomy.
For upper wisdom teeth, the equivalent problem is proximity to the maxillary sinus. The roots may reach its floor, and removal may create a communication between the oral cavity and the sinus. This is a complication recognisable during the procedure and managed immediately; the final assessment of risk depends in every case on the individual clinical situation.
Two wisdom teeth at a single appointment — the case for and against
The question comes up during planning almost every time: the prospect of two separate procedures is more off-putting than the prospect of one. This section rests on clinical practice — the literature does not settle the matter.
The case for removing two wisdom teeth at once rests above all on one recovery instead of two, one period of sick leave and one anaesthesia session. The arrangement makes particular sense when both teeth are on the same side, because the operative field is shared and the other side remains usable for eating.
The case against is the reverse situation: removing wisdom teeth on both sides at the same time leaves the patient without a side on which to chew comfortably, and compounds the swelling and the limitation of mouth opening. Difficulty itself may also be a limiting factor — two demanding procedures in succession mean a longer time with the mouth open and a greater burden.
From the perspective of the clinical team at Modern Dental & Orthodontics (Klinika MDO), what matters is that there is no single rule here: the decision is made after assessing the radiograph, the patient's general health and their plans for the coming days. Where the procedures are separated, the interval varies — usually one waits until the main symptoms on the first side have settled.
Frequently asked questions
What is chiselling of a tooth?
It is the colloquial name for surgical extraction of a tooth, most often a wisdom tooth. The term dates from the time when bone was prepared with a surgical chisel and mallet. Today the procedure involves exposing the field, removing a thin layer of bone with a bur cooled by sterile saline and dividing the tooth into fragments so that it can be removed through a smaller opening.
Does surgical wisdom tooth extraction hurt?
With effective local anaesthesia the patient feels pressure, vibration and the sound of the instruments, but not pain. These kinds of sensation are easily confused under stress. Sharp, localised pain during the procedure should be reported to the clinician immediately so that the anaesthesia can be supplemented — it is not a sensation to be endured.
How long does wisdom tooth removal take?
The procedure itself takes from about 20 to 90 minutes — difficulty is the deciding factor, and lower wisdom teeth tend to be technically harder than upper ones. The appointment, however, lasts distinctly longer: it also includes discussion of the radiograph and the plan, time for the anaesthesia to take effect and the aftercare instructions. Allow one to two hours.
Why does the clinician divide the tooth into parts?
To remove less bone. A tooth taken out whole requires an opening at least as wide as its widest outline. Once the crown and roots have been divided, each fragment comes out separately, along its own axis, through a distinctly smaller opening. A smaller wound usually means gentler healing.
How does simple extraction differ from surgical extraction?
In a simple extraction the tooth comes out whole with hand instruments, usually without sutures. Surgical extraction requires exposure of the field, preparation of a bone window, division of the tooth and closure of the wound with a suture. It takes longer and applies to teeth that have not fully erupted or have atypical roots.
Can two wisdom teeth be removed at a single appointment?
Usually yes, most often an upper and a lower tooth on the same side — access is then shared and the opposite side still serves for chewing. Removal on both sides at once tends to be discouraged. The final decision depends on the difficulty of the procedure and on the patient's individual clinical situation.
Why is a radiograph taken before the procedure?
To assess, before surgery, the position of the tooth, the shape of its roots and the distance from the mandibular canal or the maxillary sinus. A panoramic radiograph shows this in two dimensions. Cone-beam computed tomography adds a third dimension and is advised where the image suggests close contact between root and canal.
Is swelling greater after surgical wisdom tooth extraction?
Usually yes. A surgical procedure involves a larger area of tissue than a simple extraction, so swelling and limitation of mouth opening are more pronounced, and greatest on the second and third day, after which they gradually subside. The course depends on the difficulty of the procedure and varies between patients.
Summary
The greatest obstacle to surgical removal of a wisdom tooth is often not the procedure but its name. Chiselling today means preparing a small bone window with a precision bur, not working with a mallet — and it is a change worth understanding before the appointment, because it removes most of the tension.
Dividing the tooth into fragments, which sounds the most alarming, is in fact the element that conserves tissue: it allows less bone to be removed and leaves better conditions for healing. The procedure itself takes from about 20 to 90 minutes, depending on its difficulty. The risk relating to the inferior alveolar nerve is real, but transient in most cases and open to preliminary estimation on the basis of diagnostic imaging. The final decision on technique and timing depends on the individual clinical situation.
Over the following week, most depends on a properly formed blood clot; what follows if it is lost is described in our article on dry socket.
Read more:
- Dental surgery — tooth extractions at Modern Dental & Orthodontics (Klinika MDO)
- Wisdom teeth — remove or keep? A comprehensive guide to wisdom tooth extraction
- A guide to dental radiology — which radiograph and when
- Dry socket — how to recognise it and why you should not wait
- Blood clot after tooth extraction — what a normally healing socket looks like
Content and liability disclaimer
This article is informational and educational in nature and does not constitute medical advice, a diagnosis or a therapeutic recommendation — it does not replace a consultation with a specialist. If you are experiencing symptoms, have doubts or are facing a decision about treatment, consult a dentist. The methods described and the data cited are general in nature. The results of scientific studies relate to populations, not to an individual patient. The course and outcome of therapy depend on the individual clinical situation and may vary between patients. No information contained in this article constitutes a guarantee of result. The content has been prepared with due care, based on publicly available medical knowledge and the scientific publications indicated in the Sources section. We do not advise taking or refraining from any health-related action solely on the basis of the content of this article, without prior consultation with a doctor.
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