Extraction, should I be concerned?

[DF-Mark]

I am in a situation where I am pretty much forced to have a tooth extracted.
The tooth (36 Canadian) had a root canal more than 20 years ago.

I pulled the crown off the tooth a little more than a year ago while flossing.
It was the second time the crown had come off and this time my dentist
told me he couldn't replace it.

From the start (when the root canal was done) the endodontist had filed the tooth way down to little
more than a tiny stump, just coming above the gum line.
Now with all the time that has gone by the tooth has decayed to where it is barely visible and sits below
the gum line.

I have an appointment with my dentist to extract the tooth on Tuesday but am a little concerned as
a layman. I have two concerns.
The tooth cannot be gripped unless some digging is done between the tooth and the gums.
Since the tooth has been without a nerve for such a long time I'm, concerned that it may break
during the extraction. I believe there are four chambers.

My dentist tried to re-assure me last visit by saying all should be OK and even if it were to break
he could leave the piece there if it was small and couldn't be accessed!

A year ago, when I first started getting opinions on this tooth, another dentist was also prepared to
extract it and had no concerns about doing the work.

Should I have concerns, or should this be routine? Any advice?

 

[honestdoc]

I will agree with your dentist. The body has great potential to heal and to exfoliate unwanted material (leftover teeth). Your dentist will use a small dental surgical elevator and gently ease the pieces out. I am also concerned with the deteriorated tooth in front. That tooth has poor prognosis for restoration (crown). Make sure you get regular dental visits and minimize teeth deterioration through good oral hygiene, decreased sugary/acidic/creamy beverages like soda, Starbucks, Energy drinks, etc. and good Fluoride therapy.

 

[DF-Mark]

Thanks for your reply honestdoc!

I have one more question. The plan for this tooth is to extract it and then wait a couple of months before an implant is done.
Is this standard dental procedure?

I ask because I have a Russian friend who knows many people there who get there teeth removed and then have an
implant done in the same session, same day!

What are the pros/cons of each method?

 

[MattKW]

Agree with honestdoc. The extraction shouldn't be too hard, and I would have that out within a 30min appt. If you are thinking of implants, then I would advise you extract the one in front as well - it has a poor risk of lasting too long even with a crown. Then you would get 2 implants.
Immediate implants are possible in carefully considered cases. Usually for front teeth where appearances are more concerning. It is less risky to do it over a period of time: extract, allow healing, then place implants, allow healing, then crown.

 

[DF-Mark]

Agree with honestdoc. The extraction shouldn't be too hard, and I would have that out within a 30min appt. If you are thinking of implants, then I would advise you extract the one in front as well - it has a poor risk of lasting too long even with a crown. Then you would get 2 implants.
Immediate implants are possible in carefully considered cases. Usually for front teeth where appearances are more concerning. It is less risky to do it over a period of time: extract, allow healing, then place implants, allow healing, then crown.

Thanks Matt for your reply!
I visited my dentist on Jan 5th and the plan was to fill a cavity and then extract 36.

I told him I have a few questions about the extraction before he went ahead with it.
Just before my dentist started his work he said there are a few fillings he'd be doing!
This came as a big surprise and I don't like surprises when I visit a dentist.

I asked him how many fillings he did when he was finished and he said "three".
Then I explained to him why I was not too thrilled with the way he proceeded with his work.

... Around ten years ago I visited another dentist and had fillings done on around five teeth.
The next day (for the first time in my life) I slept almost non-stop for 30 hours !!!
I just got up to go to the bathroom and then went back to sleep!

Nothing else had occurred at the time. I wasn't sick. I wasn't taking any drugs or alcohol etc., no food poisoning, no stress
or other extraneous factors....

When my dentist was finished with the three fillings I asked him some questions about the extraction.
Then came the second big surprise of the day. He said he'd probably need to do a bone graft and started
talking about possibly using pig bone! He said he could use grafts from other animals or possibly a synthetic graft.

At the end of the day, it was clear that he wouldn't be doing the extraction that day! Third surprise!
He said he needed to get the graft material before the extraction was done.
So an appointment was booked for two weeks later (Jan. 20).

Well I am putting the brakes on until I am fully briefed about everything, all possibilities etc.
My dentist first started talking about this extraction more than a year ago. He never talked about a bone graft until
last visit.

I hope you folks can give me a quick course on extractions and implants.

Here are my main questions right now:

1. Why are these two procedures (extraction/implant) included in your Oral Surgery section, when there are two dentists
I visited (who are not surgeons) who are prepared to do the work?

2. How often are bone grafts done for an extraction/implant? My mother has had five or so dental implants and never had
a bone graft done.

3. What is the purpose for the grafts and what material is usually used? Do they remain in the gums?

Thanks in advance!

 

[MattKW]

1. Implant surgery can be legally done by a general dentist, oral surgeon, or periodontist. Altho I've had training in a number of implant courses, I prefer to let my periodontist do the surgery because often the patient needs some touch-up periodontal therapy on the side. Also, a peridontist is better in my opinion than an oral surgeon to handle bone and gum grafting if required. A competent general dentist can do implant surgery and grafting if they have the experience.
2. and 3. Grafting might be actual harvested bone, synthetic or bovine bone, or GTR (guided tissue regeneration. For places where there is either not enough bone for the implant to take hold (or needs supplementation), or for front implants to plump out the gum. Most grafting if for front teeth and upper molar teeth (sinus lifting). It becomes part of your body. See part 2. here.
Sometimes the decision for grafting is made before extractions and done at the same time; sometimes it is done after the extraction wound has healed.

 

[DF-Mark]

1. Implant surgery can be legally done by a general dentist, oral surgeon, or periodontist. Altho I've had training in a number of implant courses, I prefer to let my periodontist do the surgery because often the patient needs some touch-up periodontal therapy on the side. Also, a peridontist is better in my opinion than an oral surgeon to handle bone and gum grafting if required. A competent general dentist can do implant surgery and grafting if they have the experience.
2. and 3. Grafting might be actual harvested bone, synthetic or bovine bone,...

Thanks very much Matt for your helpful reply.
I really appreciate it!