Should a broken tooth be extracted

Dentist dr. G. Kortleben

Tooth extraction

A tooth usually has to be extracted when it has died, is only very loose, too much tooth substance has been destroyed by caries or when it has been broken as a result of an accident.

Tooth extraction is usually carried out under local anesthesia.
Sometimes a crown has to be removed or the roots of the tooth have to be separated from each other to remove a tooth. After the tooth has been completely removed, the wound is cleaned. When teeth are removed from the upper jaw, a check is then carried out to determine whether the maxillary sinus is still closed.

If a tooth is badly damaged or its root is broken, it usually cannot be easily extracted. The removal is then only successful after surgical exposure.

Tooth extraction with forceps

The usual surgical method for tooth extraction is a three-step process:

1. The drum apparatus is separated at the level of the neck of the tooth. This loosens the tooth. 2. The tooth is removed from the tooth socket with the help of pliers. 3. The bone compartment expanded by the extraction is compressed.

Tooth extraction with the lever

This method is used, for example, when the tooth crown is largely destroyed by caries and fractures, or when grasping with the forceps is not possible. First, the roots are separated, then they are lifted out of the tooth socket with the lever:

Tooth removal by osteotomy

This method is used for deeply damaged, retained or displaced teeth, where extraction through the tooth socket is not possible. It takes place in several steps:

1. Exposure of the jawbone

2. Removal of bone substance

3. Removal of the root remains

4. Suturing the wound

Removal of disturbing bone parts

In order for the dental prosthesis to be firmly in place, disturbing bone parts may have to be removed either during the extraction or later. This method has the following steps:

1. Exposure of the jawbone

2. Tooth extraction

3. Removal of disturbing bone parts

4. Smoothing of the bone margins

5. Suturing the wound

Smoothing of the bone edges and suturing of the wound

Removal of impacted teeth

Retained teeth are teeth that have not adjusted properly to the row of teeth, have remained wholly or partially in the jaw, or are growing in different directions.

If these teeth are not removed, chronic inflammation or cyst formation can occur.

Neighboring teeth can also be damaged or displaced. This is where the wisdom teeth are most commonly affected.

Retained and displaced teeth

Exposure of retained teeth

Retained or displaced teeth are teeth that have not emerged from the bone. Often it is also the case that these teeth are not only retained, but also have a displacement, i.e. H. they are not in line with the axis in the jawbone.

In combination with orthodontic treatment, there is the option of surgically exposing retained teeth and placing them in the right place in the row of teeth with fixed braces (usually upper canines), which can make a subsequent replacement with dentures superfluous.

Abscess opening

An abscess is an acute infection that spreads quickly and can destroy surrounding tissue in the process. The spread occurs in three phases:

1. at the root tip in the jawbone

2. under the periosteum

3. under the skin or under the mucous membrane

The therapy is divided into:

1. Opening the root canal

2. The abscess opening through the mucous membrane

3. Keeping the wound open with a tamponade

4. Antibiotic therapy

Cyst surgery

A cyst is a fluid-filled cavity in the bone or soft tissue that is caused by inflammation in the area of ​​the tip of the root.
Cysts can grow slowly and steadily, displacing adjacent teeth, maxillary sinus, and nasal cavity walls.

Smaller cysts are completely removed and the resulting cavity is closed by sewing up the mucous membrane so that it can be completely converted into bone tissue by the body after several weeks. Larger cysts cannot be removed in their entirety. The cyst is opened and the cavity is kept open by repeated tamponings until it has slowly filled up again through bone build-up.

Apicectomy

Inflammation in the area of ​​the root tip can develop on diseased teeth. Since it dissolves the surrounding bone and continues to spread, it must be treated in good time.

As an alternative to removing the tooth, an apicectomy can be performed after previous root canal treatment. The affected root tip is surgically exposed and removed together with the surrounding and inflamed tissue.

Bone augmentation

Various causes lead to bone loss, so that bone grafting must be carried out before implantation. If there is not enough bone substance, the dental implant cannot find a hold.

However, defects can be covered with bone substitute material. This is fixed with membranes. The healing time takes about 6 months. Then the dental implants can be screwed in.

The implantation takes place after a comprehensive examination and consultation as well as any necessary prior surgical interventions.

Insufficient bone substance Attaching the bone substitute material Successful bone building

Sinus lift

If the posterior teeth in the upper jaw are lost prematurely, the maxillary sinus expands. There is not enough bone to support an implant.

The maxillary sinus is opened through a side window and the jawbone mucosa is lifted into the maxillary sinus with the help of special instruments. This creates a cavity that is filled with bone substitute materials.

The bony floor of the maxillary sinus is strengthened to give the implant a better hold.

Access to the maxillary sinus Attaching the bone substitute material Firmly anchored implants