Modern dentistry is tooth-preserving dentistry. Therefore, tooth extraction is resorted to only after all kinds of attempts to preserve it. However, if this did happen, do not despair: thanks to today’s progress in the field of dentistry, firstly, it does not hurt, and secondly, it will save you from multiple problems in the future.
Indications for removal :
The indications for tooth extraction are strictly individual, here are just some of them:
– significant destruction of the coronal part of the tooth by a carious process, which leads to the technical impossibility of tooth restoration;
– necrosis of the pulp of the tooth and the impossibility of endodontic treatment due to the complex topography of the root canals or the difficulty of accessing these teeth (for example, wisdom teeth).
– great mobility of the tooth, which arose as a result of periodontitis;
– fracture of the coronal part of the tooth below the level of the gums;
– fracture of the tooth root;
– impacted (unerupted) teeth (not all impacted teeth require extraction);
– dystopic (not in place), non-functional teeth;
– supernumerary teeth (according to indications);
– tumors or tumor-like formations that are associated with teeth and which cannot be removed without removing such teeth;
– teeth localized in the fracture line in case of jaw injuries;
– teeth that interfere or make impossible rational prosthetics or orthodontic treatment.
Contraindications to removal:
Contraindications are divided into general and local. General contraindications are related to the patient’s general health and include coagulopathy, uncontrolled diabetes mellitus, malignant hematologic diseases (leukemia), uncontrolled heart disease, and certain types of drug therapy. Local factors include tumors localized in the area of the tooth, radiation therapy to the extraction area. Contraindications are also divided into absolute (when it is absolutely impossible to remove a tooth on an outpatient basis) and relative (removal is possible after special preparation or a change in the patient’s condition).
Since tooth extraction is an operation, the operated area and the tooth itself must be anesthetized. This is done with an injection of a local anesthetic.
In order to remove a tooth that is firmly embedded in the bone, the doctor first needs to loosen it. When the tooth is loose enough, the doctor can easily remove it. During the procedure itself, you will feel pressure, but you will not feel any pain, because the anesthesia blocks pain sensitivity, but does not block tactile sensitivity.
If the roots of the tooth have a complex configuration and it is not possible to remove the entire tooth, then I the tooth is saved into fragments and removed in parts. If necessary, the hole is sutured after removal.
The first day after tooth extraction, you must strictly follow the doctor’s recommendations. As a rule, they boil down to the following:
– remove the hemostatic tampon from the oral cavity no earlier than 15-20 minutes after removal;
– it is forbidden to take food and water for 2 hours after the operation;
– it is forbidden to eat hot food during the day;
– baths are not recommended for 2-3 days;
– it is recommended to limit physical activity for 2-3 days;
– for pain, the use of pain relievers is recommended;
– the use of warming compresses is strictly prohibited;
– in case of pain, a few days after removal, it is necessary to urgently consult a doctor.
Root apex resection is an operation in which the root apex of an infected tooth is removed in order to heal a pathological focus (for example a cyst or foreign body) and preserve the causative tooth.
Unlike surgery to remove a tooth, resection surgery allows you to preserve the tooth, and with it the integrity of the dental arch. Therefore, such an operation is called tooth-preserving and is used most often for the anterior group of teeth in the upper jaw.
Before the root apex resection, endodontic treatment of the tooth must be performed. The operation consists of the following stages:
• cutting out a mucoperiosteal flap on the alveolar process;
• apex curettage, removal of cysts, granulomas;
• root apex resection with access to the tooth canal;
• filling the root, filling the bone wound with osteotropic and hemostatic drugs and suturing the mucoperiosteal flap.
Vestibuloplasty is an operation to deepen the vestibule of the oral cavity, which consists in moving the facial muscles attached to the crest of the alveolar ridge, deep into the vestibule of the oral cavity.
Vestibuloplasty is recommended for patients with a small threshold as a prevention of gingival recessions and periodontitis. This intervention is also carried out for orthopedic indications (to improve the fixation of removable dentures), and in some cases – before orthodontic treatment. Vestibuloplasty is also used for implantation, when the high attachment of muscles to the alveolar ridge causes inflammation of the gums in the area of dental implants.
There are many techniques for performing vestibuloplasty, but they all boil down to the following stages (thorough diagnostics and planning of the procedure are carried out before surgery):
- Cutting out a flap.
- Exfoliation of mucous cords, periosteum.
- Moving strands.
- Antiseptic treatment
Implantation is a method of implanting an artificial root (implant) into the jawbone.
Implants are used as supports on which either crowns (fully replacing lost teeth) or removable or non-removable dentures are fixed.
The main indications for dental implants include:
- One or more missing teeth.
- Complete absence of all teeth on the jaw.
- Poor fixation of complete dentures.
- Prevention of bone atrophy in the absence of a tooth and functional load on the bone.
The implant design consists of two main parts – the implant itself, which is a titanium screw that is surgically implanted into the jaw, and an abutment, also made of titanium, which is attached to the implant after the engraftment period.
Dental implantation procedure
The first stage of dental implantation. The procedure consists in immersing the implant into the jawbone. After that, a period of time from 2 to 6 months is required. (depending on the location of the implant and the quality of the patient’s bone) for engraftment of the implant with the bone (osseointegration).
The second stage of dental implantation is a micro-operation in the area of the installed implant. At this stage, the implant is opened and the head (gum former) is screwed onto it, which protrudes into the oral cavity. After 2 weeks, the gingiva former is removed and a titanium abutment is placed in its place and the next stage of treatment is started – the manufacture of a denture.
The third stage is called orthopedic, and a dental crown is made. After placing the abutment, impressions are taken from the dentition. On the basis of these impressions, models of the dentition are made, according to which an artificial crown is made, chosen to match the color of the patient’s teeth.
The operation to install implants, like any method of treatment, has its own indications and contraindications. Indeed, there are contraindications to implantation, but only some of them are absolute, that is, they categorically exclude dental implantation. Most of the contraindications to implantation are relative and can be eliminated after appropriate treatment.