1. 1. Tooth extraction
There are various reasons why a tooth can no longer be saved or why it does more harm than good in the oral cavity.
- A crown may be destroyed beyond repair.
- A tooth may be loosened by a periodontal problem.
- A root may be inflamed and can no longer be salvaged by surgery.
- A wisdom tooth may displace or damage other teeth.
- A tooth may be supernumerary.
- A tooth may cause crowding and has to be removed for orthodontic treatment.
- A damaged tooth may have to be extracted prophylactically before radiotherapy or heart surgery.
- A tooth cannot be fitted into a planned prosthodontic treatment concept without jeopardizing the treatment outcome.
- A root may be severely injured in an accident, so that the tooth can no longer be saved.
- A deciduous tooth may not come off in time and interferes with the eruption of the permanent tooth.
Often enough, teeth can be extracted in local anesthesia. High-risk patients may need cardio-circulatory monitoring by an anesthetist. At times, general anesthesia with endotracheal intubation may be required. But, of course, it is also possible to opt for a sedative and a local anesthetic (“sedoanalgesia”) instead.
In any case, the treatment most adequate to your needs will be defined pre-operatively together with you.
Inflammatory conditions extending beyond the root canals into the bone may not be accessible by standard dental treatment. But the tooth affected may still be salvaged in many cases by removing the tip of its root surgically.
Once a major defect has developed in the bone secondary to an inflammatory process, bone substitutes packed into the defect may help the body to regenerate the bone and to improve the chances of a successful restoration.
The options for analgesia and sedation are the same as for tooth extractions.
Root canaling – endodontics
Endodontics is the medical term used for root canal treatment. When the root tips of inflamed teeth have to be removed surgically (apicoectomy), the root canals often also need filling.
Two variants of root canaling are distinguished:
1. Retrograde filling
When a tooth has had prior root canal treatment, it may sometimes be necessary to prepare and fill the root canal through the operated root tip. This is called retrograde filling. It is not easy because of the limited space available for maneuvering. But thanks to sophisticated minimally invasive surgical techniques retrograde filling can be successfully done even in the posterior jaw and at sites difficult to access.
2. Orthograde filling
When a tooth has not had prior root canal treatment, the root canals are filled through the crown during surgery. This is called orthograde filling.
To improve the outcome of these procedures, which are often done in areas not easily seen, the surgical microscope is very useful. It helps to see and treat structures, which cannot be seen by the naked eye, and thus substantially increases the chances of a successful restoration.
If a major defect has developed in the bone secondary to an inflammatory process, bone substitutes packed into the defect may help the body to regenerate the bone. Again this improves the chances of a successful restoration