Un-restorable toothTooth before extraction and implant placement

 Unrestorable tooth.  Immediate extraction and implant placement.

This patient presents with a failing crown on tooth number 35. That means the fifth tooth from the middle on the bottom left. Looking at the Xray on the right it is the tooth with the missing piece.  The tooth has been previously root canaled. The photo on the right was taken two weeks after the xray, it has broken off since the xray was taken.  I presented him with three options:

  1. Partial denture (flipper).  A removable appliance that would replace the missing tooth.  It is taken out at night and cleaned daily.
  2. Bridge.  For this patient that means removing the crown on the tooth next to it, and preparing the two teeth adjacent to the space for crowns. A bridge is simply two crowns with a pontic (false tooth) anchored between.
  3. Implant.  I proposed that we extract the tooth and place the implant in at the time of surgery. This saves the patient a surgery visit and also helps preserve bone. 

Removing the tooth and placing the implant

 

The tooth was extracted atraumatically.  Today we understand that preserving bone is important for both implants and bridges to achieve the best esthetic result. Preserving bone is much easier then adding/grafting bone.

Atraumatic extraction; no bone removal or damage
Patients tooth area is frozen with local anesthetic. The tooth is removed by carefully wedging an instrument between the root and bone until the tooth becomes loose. Then a firm grip and the tooth is gently wiggled out. No bone is removed in the process.  The photo on the left shows a clean extraction site.  No bone was harmed during the process.

We take an x-ray to confirm the extraction site and angle.  Notice the white material at the tip left from the root canal.  I removed this before placing the implant.

 

 

Confirm angle, notice root canal filling material, later removed.

Once I determine the final placement of the implant, it is screwed into place. All voids around the implant and bone are filled with a bone graft material. Everything is covered with a membrane to prevent loss of material or infection.

 

 

 

 

The xray on the left was immediately taken after implant placement but before any bone material is added.  The photo on the right is of the membrane with sutures to hold it down.

Confirm placement. All voids are filled with bone graft material.Photo taken after surgery. Membrane is held down by sutures.

4 weeks later

We bring the patient back to check healing. Then 4 weeks to remove the membrane (painless procedure, no freezing). The photo on the left is immediately after removing the membrane.  We wait 3-6 months for the implant to integrate with the bone. We will be taking an xray in the next couple weeks to see if the implant is ready for a crown.

Implant site 4 weeks after placementX-ray of implant 3 weeks after placement.

The patient returned in 4 months for a second stage surgery and healing cap.