Surgical Tooth Extractions
in Honolulu, HI
 Surgical tooth extractions in Honolulu are necessary when a tooth cannot be removed with a simple lift, typically because of decay below the gumline, a fractured root, or a tooth that did not erupt properly.
At Pacific Maxillofacial Center, our board-certified oral and maxillofacial surgeons handle surgical extractions and the full range of oral surgery procedures at our Honolulu and Waipi’o offices, using the techniques, imaging, and anesthesia options that complex cases require.
A surgical extraction differs from a routine tooth extraction in a few specific ways. We may need to make a small incision to access the tooth, section the tooth into pieces for safer removal, remove a thin layer of bone surrounding it, and place a few sutures afterward. Most patients are aware throughout and comfortable, with sedation options matched to the case and to how comfortable you want to be.
On This Page
What Makes an Extraction "Surgical"?
The line between a routine extraction and a surgical one is whether the tooth can be removed in one piece with simple instruments. If it cannot, we move to surgical techniques. Several specific situations require this approach:
- Decay Below the Gumline – When a tooth has broken down so far that there is not enough crown left to grip with extraction instruments, we have to access the root surgically.
- Fractured Roots – Roots that have broken during a previous extraction attempt or under trauma often require surgical removal of the remaining fragments.
- Bony Impaction – Teeth partially or fully covered in bone require flap elevation and bone removal. Most cases involve impacted wisdom teeth, which is its own surgical category.
- Ankylosed Teeth – Teeth that have fused directly to the surrounding bone instead of being held by the periodontal ligament cannot be removed without sectioning.
- Curved or Hooked Roots – Some teeth have root anatomy that prevents simple extraction without breaking the tooth into smaller pieces first.
- Adjacent Anatomy – Teeth close to nerves, sinuses, or important structures often need a controlled surgical approach to protect surrounding tissues.
For multiple teeth removed in a single visit, multiple extractions are typically handled under one sedation appointment when the case allows.
 Before any surgical extraction, we take cone beam CT (CBCT) imaging to see the tooth, surrounding bone, and nearby anatomy in three dimensions. That imaging is the difference between knowing exactly where the roots are and what is around them, versus working from a two-dimensional X-ray and finding out mid-procedure.
Your Oral Surgery Team in Honolulu
Pacific Maxillofacial Center was founded in 1999 by Dr. Todd K. Haruki, who completed 12 years of graduate and post-graduate surgical training, including a hospital-based oral and maxillofacial surgery residency at the University of Louisville. He is a Diplomate of the American Board of Oral and Maxillofacial Surgery and a Fellow of the American Dental Society of Anesthesiology.
Dr. Neil Oishi holds DDS and MD degrees from the University of Southern California and the University of Florida College of Medicine respectively, and completed his oral and maxillofacial surgery residency at the University of Florida. He is also a Diplomate of the American Board of Oral and Maxillofacial Surgery and serves as an on-call facial trauma surgeon at Queen’s Medical Center.
That dual DDS-MD training matters specifically for surgical extractions. The combination of dental and medical education means our surgeons evaluate not just the tooth but also your surrounding anatomy, your medical history, and any complicating factors. Hospital-based surgical residencies cover the range of complications that can arise during oral surgery, and we bring that preparation forward into our office setting with continuous monitoring, in-house anesthesia, and recovery staff trained to assist with IV sedation and outpatient general anesthesia.
The Surgical Extraction Process
 Most surgical extractions follow a predictable sequence, though the time spent on each step varies with the difficulty of the case.
Step 1: Consultation and Imaging
At your first visit, we review your medical and dental history, examine the tooth in question, and take CBCT imaging if it would change the surgical plan. We discuss sedation options and which level fits the case. If anxiety is a factor, our dentistry for anxious patients page covers how we approach that conversation specifically.
Step 2: Day of Surgery
On surgery day, we numb the area with local anesthesia, administer any sedation you have chosen, and proceed with the extraction. For a typical surgical extraction, we make a small incision to expose the tooth, remove any bone covering it if needed, section the tooth into pieces if its anatomy requires it, and remove each section. We then irrigate the site, smooth the bony edges, and close with sutures.
Step 3: Bone Preservation Decision
If you are planning a dental implant at the same site in the future, this is when we discuss socket preservation, a graft placed at the time of extraction to prevent bone loss in the months that follow. The decision is easier to make before the extraction than after, so we raise it during the consultation.
Step 4: Recovery
Most patients return home the same day with detailed after tooth extraction instructions. Mild swelling and discomfort over the first 48 to 72 hours is normal and manageable with the pain control we send you home with. Sutures are typically removed or dissolve within a week, and most patients are back to normal eating within 7 to 10 days.
The total chair time for a single surgical extraction is usually 30 to 60 minutes, depending on the case. Multiple extractions or particularly difficult cases may run longer.
Benefits of Choosing an Oral Surgeon
Going to an oral and maxillofacial surgeon for a complex extraction has practical advantages over having a general dentist attempt it.
Hospital-based residency training covers the range of complications that can arise during oral surgery, including how to manage patients with bleeding disorders, cardiac history, or medication interactions. Both Dr. Haruki and Dr. Oishi completed full hospital residencies, and Dr. Haruki’s additional ADSA Fellowship adds anesthesia depth to the team. When something unexpected happens during a procedure, that combined training is what determines how it gets handled.
We also have all five levels of sedation available in our own offices, which means the same team manages your anesthesia from the first conversation through recovery. For longer or more anxiety-prone cases, that single point of accountability matters.
Our use of CBCT planning lets us preserve as much surrounding bone as possible during the extraction. That matters for two reasons: faster healing now, and better implant candidacy later if you plan to replace the tooth. The bone you keep during extraction is bone you do not need to graft back in.
We also keep complex cases on a single appointment when it makes sense. Combining an extraction with a same-visit bone graft, or with sedation that allows multiple tooth removal in one sitting, reduces the number of visits, appointments to schedule, and rounds of recovery you go through.
Why Choose Our Practice for Surgical Extractions
Our two-office structure on Oahu means patients in Honolulu and the West Oahu corridor can both reach a board-certified oral surgeon without a long drive. The Honolulu office is at 1060 Young St #312, and the Waipi’o office is at 94-1221 Ka Uka Blvd #B-204 in Waipahu.
For surgical extractions specifically, the technology in our offices matters. Our dental technology stack includes cone beam CT for 3D imaging of the tooth and surrounding anatomy, Trios intraoral scanning for digital impressions when restoration planning is involved, and X-Guide navigation when implant placement is coordinated with the extraction.
Dr. Haruki’s ADSA Fellowship and both surgeons’ MD-level training give the office in-house anesthesia oversight for the deeper sedation options that complex extractions sometimes require. We do not refer patients to outside anesthesiologists for general anesthesia, which keeps the surgical and anesthesia plan with the same team.
We also see a meaningful share of patients who put off a needed extraction because of dental anxiety. The combination of sedation options, an unhurried consultation, and a single coordinated team is what makes the work possible for that group.
Surgical Extraction Cost and Insurance
Cost matters, and the honest answer for surgical extractions is that the fee depends on the complexity of the case. A simple surgical extraction of a partially erupted tooth is priced differently than the removal of an ankylosed molar requiring extensive bone work. CBCT imaging, any bone graft material, and the sedation level you choose all factor into the total.
Dental insurance often covers surgical extractions, sometimes with medical insurance helping when the case is documented as medically necessary. Coverage varies widely between plans, and the breakdown of what is covered between dental and medical insurance can be complicated. Our front office staff handles benefits verification before treatment, and our insurance and financing section covers payment options, including monthly payment plans for patients who would like to spread the cost.
Call our Honolulu office at 808-585-8455 if you want benefits checked before scheduling.
Schedule Your Surgical Extraction Consultation
If your dentist has recommended a surgical extraction, the next step is a consultation. Call our Honolulu office at 808-585-8455 or request an appointment online. Our Honolulu office is at 1060 Young St #312, Honolulu, HI 96814. We also see patients at our Waipi’o office. The Contact page is the easiest way to reach us in writing.
Frequently Asked Questions
Why do I need a surgical extraction instead of a routine one?
Surgical extraction is required when a tooth cannot be removed in one piece with simple instruments. The most common reasons are decay that has destroyed too much of the crown to grip, root fractures, teeth fully or partially covered in bone, or roots with curved or hooked anatomy. The X-ray your dentist took is usually what reveals which category your case falls into.
Will the surgical extraction hurt?
The area is fully numbed with local anesthesia before any work begins, so the procedure itself is not painful. Pressure sensations during sectioning or bone work are common but not the same as pain. After the numbing wears off, mild soreness and swelling are typical for two to three days and respond to the pain control instructions we send you home with.
How long does the procedure take?
A single surgical extraction usually takes 30 to 60 minutes of actual chair time, with the full appointment running longer because of check-in, sedation setup, and post-op instructions. Complex cases involving multiple teeth or unusual anatomy can run longer; the consultation gives us the information we need to estimate your specific case.
How long is recovery?
Most patients are back to normal eating within 7 to 10 days, with the first 48 to 72 hours being the most uncomfortable. Swelling typically peaks on day 2 or 3 and then improves. We send detailed after tooth extraction instructions home that walk through what to expect day by day.
Will I need a bone graft afterward?
The need for a bone graft depends on what you plan to do next. If you are leaving the gap and not planning a future implant, a graft is usually not necessary. If you are planning a dental implant at that site, socket preservation is a graft placed at the time of extraction to preserve the bone for that future implant. We discuss the decision before extraction so it can be done in one visit if appropriate.
Can I be sedated for the procedure?
Yes. We offer all five levels of sedation, from local anesthesia alone to deep sedation and general anesthesia. The right level depends on the complexity of the extraction and your comfort preferences. For high anxiety, our dentistry for anxious patients coverage walks through the deeper levels in more detail.
Will my insurance cover the surgical extraction?
Many dental insurance plans cover surgical extractions either fully or partially, and some cases qualify for medical insurance coverage when documented as medically necessary. Coverage varies significantly between plans. Our front office staff verifies benefits before treatment so you have a clear estimate.
Can I drive home after a surgical extraction?
With local anesthesia or nitrous oxide alone, most patients drive themselves home. With oral conscious sedation, IV sedation, or general anesthesia, you need a ride home and someone to stay with you for several hours after the appointment. |
