Tooth extraction is a procedure typically performed when your tooth has been broken or is deteriorated by decay and is beyond repair. When the tooth in question is visible, tooth removal is a relatively simple procedure. Teeth that are broken, and are either flush with or below the gum surface or when impacted, require a more involved tooth extraction procedure. Historically, this meant some procedural trauma and even potentially requiring oral surgery. However, new technology and tools are revolutionizing this procedure and treatment moving forward.
A Complete Fracture of the Tooth
“There is Nothing to Grab. How Are You Going to Do That?” I hear this question all the time. The specific situation that we are referring to is one where someone comes to me with a crown that fell off. Whether this person is an established or a new patient, they both want me to reattach the crown. “Just glue it back on” is the common phrase that I hear.
When I look at the crown, I find that something hard inside of it. I try to pick out the hard material, but I am not successful in this attempt. I then proceed to examine the mouth and find where this loose crown originated. In the mouth, I find that the tooth is flat with the surrounding gum. Nothing is sticking up from the gum. What has transpired in this case is a complete fracture of the tooth. The hard material in the crown was the actual tooth structure that was broken and severed from the rest of the tooth in the mouth.
Removal of the Roots
With a few rare exceptions, the most common treatment is the removal of the rest of the tooth. There is no way to predictably reconnect the crown, with the broken tooth fragments inside of it, to the remaining in the mouth. That part of the tooth that remains inside the mouth is, in reality, the top of the roots that help anchor a tooth. The only available treatment is the removal of those embedded roots. Since everyone conjures up the image in their mind of a dentist grabbing a tooth with an instrument and pulling, the question is a natural one. How can the dentist remove the tooth with nothing to grab? Maybe once upon a time tooth removal was done solely by grabbing and pulling, but this is not the case today. An instrument is used to grab a tooth only after it becomes very loose. At that point, using our fingers alone to retrieve it would be cumbersome, so an instrument to grab is used.
Loosening the Tooth with Pressure
You are probably asking at this point as to how the tooth becomes loose. Typically, we use a series of instruments that allow us to push on the broken tooth. This pressure and pushing will ultimately result in tooth looseness. Tooth looseness is the step immediately before removal. Patients who have long roots or good bone may require quite a bit of pressure to accomplish this task. There is no pain, just a lot of pushing.
A Revolutionary New Tooth Extraction Tool
Yesterday, I used a new piece of technology to remove a two-rooted lower molar. During one of my lectures, a company representative approached me and requested that I evaluate this unique instrument. This device gently uses copious amounts of water to skip the pushing. It creates the space that allows the tooth removal in the most gentle and atraumatic way that I have ever seen. It preserves all the bone around the tooth, and there is almost no bleeding. This instrument is completely revolutionary and will change this treatment from this point forward. The procedure went so smoothly that I was able to place an implant for the patient immediately. We avoided the extra time and expense of bone grafting and delaying the final tooth by months. This patient will get a tooth back into place that he can chew in the most desirable way that is possible.
Post Procedure Follow-up
I called to check on the patient later that evening. He told me that he felt great and had no issues. He was worried about how he would feel over the holiday weekend but was no longer concerned. If you have put off having a tooth removed because of concern over the unknown, now may be the best time for you to return your mouth to a state of health. Give Joyce a call at (440) 892-1810 and find out what you can do to help you. I look forward to hearing from you.
Jeffrey Gross, DDS, FAGD is an Ohio licensed general dentist and is on the staff of Case Western Reserve School of Dental Medicine.