Definitions and Descriptions

There are cases in which, despite the best attention and technology at hand, some teeth cannot not be saved. This usually happens in the following cases:

  • Dire forms of periodontithis that have brought to a complete or almost complete reabsorbing of the sustaining bone, and consequent elevated mobility of the tooth.
  • Caries of such a depth to have reached the roots in a non redeemable way.
  • Vertical fractures of the tooth.
  • Unfavourable tooth's position (for example the wisdom tooth), especially if causing gingival trouble.

a) Simple extraction

The tooth is luxated (dislocated from its original site) by means of levers and tongs, according to the case. Teeth with more than one root are very often cut through with a bur, so as to extract each root separately. All extractions are executed with most careful maneuvers, aiming at holding the highest bone quantity possible: this is done for not compromising the possibility of doing an implant in the place of the lost tooth. Too quick extractions can sometimes demolish part of the bone and subsequently inhibit rehabilitation. The extraction can be followed or not by suture, according to the situation. As an alternative, a compressed sterile gauze can be used to help the forming of the clot.

The patient is asked not to rinse eccessively: he can remove the presence of blood in his mouth with a quick rinse, knowing that the eccess will slow the clotting down. It'll be abviously indicated to avoid chewing on the wounded side, with the aim of avoiding to disturb healing and infection of the extractive site. Hemorragical situations must be controlled by compressing the area with a clean gauze or a clean fabrice tissue (never with cotton or paper towels!). According to necessities, the patient may face eventual post operative pain by means of anti dolorific drugs, following the doctor's indications, preferring those not containing Salicilate (aspirin), because they have anti-coagulating characteristics. In cardiopathic patients being under chronic treatment with aspirine, the assumption of the drug will have already been interrupted before the extraction, with the approval of the family doctor.

A possible (but not frequent) complication of the extraction is the wound infection, showing with an increasing pain in the next days, swelling and bad smell: this inconvenience is of course to be handled with an antibiotical drug.

b) Surgical or complex extraction

Some teeth require much more complicated maneuvers to be extracted than the conventional ones. More or less these complication resides in the position these teeth have in the mouth. A typical example of this is the extraction of an included or semi-included wisdom tooth. The third molar (especially the lower one) often bears the bad habit of not erupting (coming out) in a regular way, or not of erupting at all. In this case, the extraction turns itself into a real surgery in which the gum must be cut to reach the tooth through the bone. Also in certain cases of semi-inclusion, the dentist will have to create an access through the gum and sacrifice a certain amount of bone to be able to extract the tooth.

The post surgical consequences are more or less those already descripted in the simple extraction section.

With this kind of surgery, we plan to increase the quantity of bone in a given area of the mouth, with the aim of obtaining enough to perform implantology where it was impossible. The surgery techniques differ from maxilla to mandibula.

a) Bone fillers

The substances being employed to form new bone are of different kinds and vary from liophilized bone of animal origin, to synthetic products based on Calcium. It's not easy to exactly decide which of these guarantees a better attachment, however more recent research seems to indicate that deproteinated bone of bovine origin even performs better than the patient's own bone.

b) Minor and Major Sinus lift

It's applied to the maxilla, particularly to the posterior sectors (molars). It practically consists in compensating for bone scarcity by filling a natural cavity which is found above the teeth's roots, more or less under the cheekbone, called maxillary sinus: it's a sort of lateral nose cavity and is one of the so called "paranasal sinuses".

The minor sinus lift consists in pushing regenerative material into the sinus, through an extraction cavity or an implant drilling: as a matter of facts, this technique is applied within the same surgical act in which the implant is placed and may offer a height gain up to 4 mm.

The major sinus lift is a more delicate surgery and consists in the opening of a lateral door, giving access to the sinus and being cut on the lateral external maxillary wall, facing the inner cheek. This technique allows to obtain much bigger bone augmentations, and also to practically completely fill the sinus. According to the technique used, implants can be placed in the same surgical act.

 

c) Crestal bone augmentation

It can be applied both to the maxilla and the mandibula, however its main use is in the lower jaw, where there are no cavities that can be filled. In this case the substance is put over the bare mandibular bone. A very frequent and safe surgery in this case is the drawing of natural bone from the patient's iliac crest, in general anaesthesia and the immediate placing ton the receiving site. Of course, this is a too complex surgery to be performed in a normal dental office, and requires the competence of a good maxillo facial department in a hospital.