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.
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.
- 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
- 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