Do I Need a Tooth Extraction?
Periodontists assess the supporting structures of teeth and can help diagnose if a tooth has a good chance of functioning or if it needs to be extracted. Our goal is to preserve the natural tooth as long as possible. But there are several situations when a tooth may need to be extracted: where there is severe decay, advanced periodontal disease leading to bone loss, a cracked or broken tooth that cannot be repaired, a poorly positioned tooth that is negatively affecting adjacent teeth or is difficult to clean and harbors bacteria, and as preparation for orthodontic treatment.
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Extraction Site Preservation
There is a special type of bone surrounding your teeth. This bone is called alveolar ridge bone, and exists solely to support your teeth. As soon as the tooth is removed, this bone begins to degenerate and melt away. The overlying gum tissue melts away with the alveolar bone and thins out as the ridge flattens. This occurs in two dimensions. The first is loss of horizontal width caused by the collapse of the bone surrounding the socket. The second is a loss of vertical height. This makes the remaining bone less tall. This process is faster in areas where you wear a partial or complete denture. You have many options to prevent this, and it is important that you consider them before any teeth are extracted. Some of these procedures are best performed at the time the tooth is removed. When you need to have a tooth extracted, a socket site preservation is recommended to preserve as much of your underlying bone as possible for your future restorations.
Alveolar Ridge Preservation
There are two important phases in retaining your alveolar ridge during and after tooth extraction. Non-traumatic extraction techniques are designed to preserve as much bone as possible and reduce bleeding and discomfort.
In addition to non-traumatic extractions, and key to preventing the collapse of the socket, is the addition of bone replacement material to the extraction socket. Although the bone created by socket grafting supports and preserves the socket, it will not do so indefinitely.
Placing dental implants three to twelve months after the extraction and socket grafting will provide the best long-lasting support for preserving your jawbone and allow you to function as before.
Otherwise, the graft may melt away or resorb over time. In some select cases it is possible to actually extract the tooth and place the dental implant at the same time. Your periodontist will discuss this option with you if it is a viable alternative.