Teeth Extractions

Treatment options for a broken or decayed tooth? What happens if deeply broken or decayed teeth are not extracted? What is the emergency treatment for a painful tooth? What are the possible treatments during extraction? What is the best way to replace a tooth? How soon can I get a replacement tooth? What happens if an extracted tooth is not replaced? Can I have several extractions done at the same time? How is loss of a tooth in the smile zone managed? Best anesthesia option Treatment options for a broken or decayed tooth? Teeth that break or with deep decay require extraction if they are significantly damaged and restoration is not possible. In cases of moderate fracture or decay, it may be possible to save the tooth by having a root canal procedure, a build-up and a crown. In these cases, gum/bone tissue surgery may also be necessary to allow proper placement of the crown. While these procedures may be successful, they may only be a short-term solution. Extraction and replacement with a dental implant offers the best long-term prognosis. What happens if deeply broken or decayed teeth are not extracted? Pain and Infection are the main concerns. Infection can become dangerous if it spreads to the face and neck. It also causes gradual loss of jaw bone surrounding the tooth, not mention severe pain. Immediate extraction is recommended to avoid such complications. What is the emergency treatment for a painful tooth? Whether the tooth is broken from deep decay or trauma or has been painful, the first step is an examination and X-ray evaluation by your dentist or oral surgeon. If it is restorable, root canal procedure may be recommended, followed by build-up and a crown. If not restorable, then extraction is necessary. If it is a front tooth, your dentist may first obtain an impression to prepare a temporary prosthesis before referring you to an oral surgeon for extraction.  Dr. Kazemi and his staff are well experienced in emergencies and can often see you right away. Your dentist can make a temporary prosthesis very quickly, sometimes on the same day, so you don’t have to go without a tooth for long. This is especially important if it is a front tooth in the smile zone. What are the possible treatments during extraction? Dr. Kazemi will initially examine your tooth in question and evaluate X-rays provided by your dentist. Anesthesia options will be discussed, other X-rays may be taken. You are then prepared for the extraction. Depending on the tooth’s location, root anatomy, and health of the surrounding tissues, Dr. Kazemi may decide to perform bone grafting or immediate implant placement after the extraction of the tooth. Treatment options include:
  • Extraction only: A tooth may be extracted only without bone grafting if the site has suffered no bone loss, has good bony anatomy, and delayed implant placement is planned in two to three months. This procedure often takes only a few minutes.
  • Bone grafting: If there is loss of bone, from trauma or infection, it is best to immediately place bone-graft into the extraction site to preserve and augment the missing bone for future implant placement. This is known as preservation / augmentation of extraction site and is performed at time of extraction. It is allowed to heal for four to six months before the site is ready for implant placement. If the tooth is in the smile zone, a well-crafted temporary prosthesis must be placed by the restorative dentist to help guide gum tissue healing. Bone-grafting is also indicated when the bone is normal, but a patient, for whatever reason, may have decided to postpone an implant beyond three months. Bone undergoes resorption and remodeling after an extraction, and it is best preserved by immediate bone-grafting. The upper front teeth are particularly susceptible to bone shrinkage following extraction, and grafting is the only way to preserve it. Any loss of bone the results if grafting isn’t done, will be more difficult and more costly to treat later. Bone-graft materials most often used are either freeze dried bone, bovine bone, or synthetic bone in form of calcified granules in pre-packed bottles. They are very safe and patients shouldn’t be concerned about disease transmission. Once placed, the bone graft material is covered with a resorbable membrane that protects it and allows it to mature into actual bone over a four to six-months. A dental implant may then be placed safely into a mature and normal bone.
  • Immediate Implant placement: Sometimes, a dental implant can be placed at the time of extraction. This is called an immediate implant. This technique is safe and predictable if done in specific extraction sites. These include single-root teeth that have a short and narrow root form, and infection-free, and have normal amount of bone present. Some minor bone-grafting may also be necessary during this procedure. Occasionally, a temporary crown may also be placed on the same day.  This “Teeth-In-A-Day” concept is successful if performed in appropriate sites and techniques. Placement of an immediate implant in inappropriate sites have high risk of failure and should be avoided.
What is the best way to replace a tooth? Dental implants are now the standard-of-care for tooth replacement. They can last a lifetime, unlike bridges, partials and dentures that may need to be replaced several times. Since dental implants prevent the bone resorption that occurs when teeth are missing, the natural appearance of the smile is preserved. With implant treatment, there is no compromise to adjacent teeth; they are not cut down to place a bridge, or loosened by the hooks on removable partials. Dentures and partials have the added disadvantage of accelerating the bone resorption process, which causes the appearance of premature aging. How soon can I get a replacement tooth? A temporary tooth can be made on the day of extraction or within several days. An immediate implant may be placed if appropriate, otherwise the extraction site is allowed to heal for six to eight weeks. Once the implant is placed it may be restored immediately if possible or in eight to twelve weeks once adequately healed. What happens if an extracted tooth is not replaced? Not replacing a tooth will result in shifting of adjacent and opposing teeth altering the bite and its balance. The supporting bone also gradually melts away. It is best to replace the tooth with an implant as soon as possible to prevent teeth shifting and loss of bone. Can I have several extractions done at the same time? Yes. All necessary extractions can be done on the same visit. This does not prolong healing time or post operative pain. In-fact it saves time and lessens exposure to anesthesia and other medications. How is loss of a tooth in the smile zone managed? Loss of a tooth in the smile zone (upper front teeth) must be managed carefully as it is highly visible. Extraction should be done in an atraumatic fashion. Immediate implant should be considered if appropriate. As bone is extremely thin in this region, site grafting should always be considered to prevent thinning of bone and gum tissue which will result in significant aesthetic compromise. Any temporary prosthesis must shape the gum tissue where teeth are missing. Once implant is placed, it is always recommended to restore it with a temporary crown for three to four months before making the final crown. Best anesthesia option Teeth extractions do not have to be traumatic. Poor experiences in a dental or oral surgery office can change one’s outlook on dentistry for life, especially for young adults. Teeth extractions while routine, is not simple and the right choice in anesthesia can make all the difference in your experience. IV sedation is the best option for teeth extractions. There are three options for anesthesia: IV sedation: This is the most common approach and desired by most patients. The patient is asleep during the procedure and awake immediately upon completion. This is a very safe technique with continued monitoring or breathing, heart rate, blood pressure, EKG, and oxygenation during the procedure. Patients are discharged home after a 20- to 30- minute recovery. Nitrous oxide: This is commonly referred to as laughing gas. While it provides some relaxation, the patient is still awake and aware of the procedure. This approach may be good for simple procedures or those who are less anxious. Local anesthesia: This is the ‘numbing’ only approach. The patient is fully awake. Although he or she is numbed adequately, so there is no pain, there are other sensations that may be uncomfortable, like pressure, vibrations, or sounds. Oral sedatives such as Valium or Xanax can provide some relaxation when taken one hour prior to a procedure. The medication is absorbed through the digestive system, therefore, its clinical effect and degree of relaxation is highly variable and unpredictable.