Part 3: To Save or Extract a Tooth? That is the Question

Thoughts from our Dental Implants Specialists

 
This is our last blog that addresses the question to save or extract a tooth. The first blog discussed the structural, periodontal and esthetic requirements of saving or extracting a tooth. Appreciating the concepts of “Biological Width” (Figure 1) and  “Ferrule” (Figure 2), one can understand the relationships between the periodontal (gum) tissues and restorative dentistry. The second blog discussed a periodontal procedure called “crown lengthening” as a means of saving a tooth, when a tooth needs a crown. This blog will discuss removing teeth and replacing them with dental implants when the esthetics will be compromised if the teeth are kept.

Dental Implant Therapy

Dental implants have become the standard treatment modality to replace single and multiple missing teeth. Dental implants have been used in the U.S. since the early 1980’s. A recent systematic review by Moraschini et.al,  have affirmed that osseointegrated implants are safe, present high survival rates, have minimal marginal bone resorption with clinical documentation over a period of at least 10 years.1   Significant clinical and scientific research have documented that dental implants are predictable, safe and can  preserve both the bone and gum tissues.

Case Report

This case below will illustrate a clinical scenario where our patient had  trauma to her front teeth (Figure 3). The front teeth would require crowns in order to be saved. Since there was inadequate tooth structure remaining above the gums, the teeth would require crown lengthening  in order to make properly fitting crowns.  However, if crown lengthening were performed on the front teeth, the resulting gingival (gum) esthetics would be completely unacceptable because of the surgical procedure necessary to expose adequate tooth structure (Figure 4). In this case, the patient’s front teeth were removed and replaced with same day  dental implants  (Figure 5). Since the implants achieved a favorable initial stability,  temporary crowns were placed on top of the implants (Figure 6). This treatment method can result in a highly favorable esthetic result because the placement of an immediate dental implant with temporary crowns, help to preserve both the bone and soft tissues (Figure 7).  The success rates for immediate implants placed after tooth removal compare favorably to the traditional delayed-2 stage approach.2  After a healing period of 4 months, a final impression was taken to fabricate individualized ceramic (white) abutments and crowns. (Figure 8).

In conclusion, to accurately answer the question, “to save or extract a tooth,” will depend on the periodontal, structural and esthetic requirements of the individual tooth and the desires of the patient. The doctors at PDG are specialists with the training and expertise  to assist you in the decision to save or extract a tooth. Your partner in dental health, Dr. Tassos Sfondouris, DDS, MS.

Figure 1: “Biological Width” and it describes a peripheral gum “seal” around our teeth that measures on average 2mm.
(Image taken from Spear Education)
Figure 2: To Determine whether the teeth can be retained, we need 4mm of tooth structure above the gums. 2.5mm from gums to the bone and a 1.5mm ferrule. These can be achieved with crown lengthening via bone removal, but the results would be be unacceptable esthetically.

 

Figure: 3 Front view of the fractured two front teeth.
Figure 4: Fractured front teeth showing an inadequate ferrule. Crown lengthening would alter the gum esthetics resulting in an unfavorable final esthetic result.
Figure: 5 The front teeth were removed and 2 single implants were immediately placed on the same day.

 

Figure 6: After the implants were placed to replace the two front teeth, temporary crowns were placed on top of the implants on the same day.
Figure 7: Immediately placed implants with temporary crowns helps to preserve the original bone and tissue volume of teeth.
Figure 8: Completed implant crowns on the front teeth. Veneers were completed on the adjacent teeth.

References

  1. V. Moraschini, L. A. da C. Poubel, V. F. Ferreira, E. dos S. P. Barboza: Evaluation of survivaland success rates of dental implants reported in longitudinal studies with a follow-up period of at least 10 years: a systematic review. Int. J. Oral Maxillofac. Surg. 2015; 44: 377–388
  2. Lang NP. et al. A systematic review on survival and success rates of implants placed into fresh extraction sockets after atleast 1 year. Clin Oral Implants Res. 2012 Feb;23Suppl 5:39-66

 

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