Parkview Dental Care - David Bertagna, DDS
One of the most difficult decisions a person has to make, when confronted with the diagnosis of chronic pulpitis or a necrotic pulp, is should they extract the tooth? The reason it is such a dilemma, is because the decision has two components. One component is cost. While it is typically less expensive to extract the tooth, the cost of replacing the missing tooth can be very expensive.
The other component revolves around the decision to keep the tooth. As was discussed in last month’s newsletter, the only alternative to extraction of an infected or compromised tooth is root canal therapy. This treatment has proven to be 93-97% successful when performed under the proper conditions.
Root canal therapy is statistically a viable alternative to extraction of a tooth in most circumstances. Implant surgery is considered by some dentists, to be the standard of care when compared to root canal therapy. These practitioners believe that the placement of an implant is more predictable and reliable than root canal therapy.
If one decides to extract a tooth with the intention to place an implant at the extraction site, there are typically two options available. The first option is to place the implant at the time of the extraction This option is rarely done, due to the fact that a tooth that has been condemned to extraction, usually has some disease that prohibits the use of the bone in that area to be used to support an implant.
More commonly, a healing period of three to four months is required to allow the bone to regenerate and provide a substrate for the implant to be placed into the site of the extraction. Many times, bone augmentation is performed to provide adequate placement of the bone structure lost during the extraction. There could be an additional three month healing process if bone augmentation was implemented.
Sometimes the bone augmentation is unsuccessful, requiring a bone graft. A bone graft can use the patient's bone, usually located somewhere in the oral cavity. If this is not an option, then the bone can be used from cadavers or other parts of the patient's body, typically the hipbone. This procedure is rarely used due to the successful use of hydroxyapatite and other bone substitutes.
When the bone has healed and there is adequate bone structure for the implant, the implant is placed into the bone. The implant is basically a special screw that is designed to be used as a foundation to replace the root of the tooth. When the implant has integrated with the bone, which means the implant has bonded with the bone, the process to build the part of the tooth that will be used inside the mouth can begin.
Just as a home has a foundation that is used to support the structure that is called the house, the implant supports the structure will become the tooth. The abutment is the term used to describe the structure that connects the implant to the visible structure that could be compared to the framework of a house.
The framework of a house is covered with wood or brick and a roof of asphalt or steel to seal the outside from the elements of nature. This construction protects the house from the effects of the conditions of the outside from affecting the inside of the house. Similarly, the implant and abutment are covered with a crown to seal the structure of the implant and abutment from the environment of the oral cavity.
Just as a crown is the final restoration for a tooth that has been compromised by a root canal, a tooth that has been replaced by an implant must be replaced by a crown. A crown is the most effective way to restore the function and integrity of an implant.
Dr. Bertagna can guide you into making the decision whether to have the root canal procedure or extraction. This most important decisions should be made with the most up to date information.