According to statistics, the 6th tooth implant is installed more often than others, which is due to the characteristics of this first molar. Sixes are the first of all permanent teeth to erupt, they are used more, and therefore deteriorate faster and more often than others. The procedure for implantation above and below differs in the choice of implant and timing of prosthetics. Implantation of a six on the upper jaw takes longer - 4-6 months, on the lower jaw - 2-4 months. Osseointegration occurs with differences due to the structural features of the jaws and different bone densities. The total duration of treatment depends on the volume of bone tissue; if there is a deficiency, bone grafting or sinus lifting is performed first.
Why do sixth teeth deteriorate more often than others?
The sixth teeth (first molars according to dental classification) are molars. The rudiments are laid at the 5th month of fetal development, and at the 9th month their mineralization occurs, which continues throughout the first month after the birth of the child. Their final formation with enamel occurs only by the age of 2-3 years. Therefore, the condition of the root and crown depends on the course of pregnancy and childbirth.
Sixes do not erupt in early childhood, since the function of chewing is not yet needed. When they erupt, they do not have predecessors in the form of milk teeth, so they essentially grow from scratch. Of the permanent molars, they begin to erupt first at 5-6 years, so they last longer than others. Frequent diseases, removals and the need for implants are associated with this.
How is a decayed tooth removed?
The process of tooth extraction is a simple dental operation. The difficulty increases when you need to remove the root of a tooth that is completely destroyed. Factors requiring the intervention of an experienced specialist:
- small size of the remaining crown;
- condition of surrounding tissues;
- the location of the remaining hard tooth tissues under the upper edge of the gums;
- defects of gums, roots.
Affects the complexity of the operation and whether the position of the upper or lower jaw belongs. In the upper jaw, the walls of the sockets are longer and thicker; accordingly, teeth are removed from them with great difficulty - a highly qualified dentist is required to perform the manipulation.
Wisdom teeth, from which only the root remains, are removed in the same way as ordinary molars, but in some patients, healing after such an intervention is very painful.
Examination and preparation
The procedure begins with a thorough examination and preparation of the patient. When you first visit the clinic, the doctor will take an x-ray and examine the oral cavity.
Doctor's tasks:
- determine the condition of the tooth, assess the extent of destruction;
- clarify the presence of allergies, contraindications, inflammation;
- choose a method of pain relief;
- draw up an operation plan;
- prepare tools.
The tools used to remove a rotten tooth root are a drill, forceps, and a set of elevators (photo).
A prerequisite is hygienic treatment of adjacent tissues. Extraction is possible only after removing stones and plaque from the molars, incisors or canines surrounding the surgical field. Immediately before extraction, the oral cavity is treated with a Chlorhexidine solution.
Anesthesia
There are cases when dentin is destroyed gradually, without inflammation, without the appearance of rot. In such situations, painless root removal is possible without the use of painkillers, however, anesthesia is more often necessary.
The choice of drug is carried out taking into account:
- age;
- allergic status;
- presence of somatic diseases;
- individual intolerance to drugs;
- presence of chronic diseases: epilepsy, diabetes;
- complexity of the upcoming operation.
The patient must notify the dentist about any deviations before the procedure begins. In most cases, the tooth root is removed under local anesthesia - one or two injections for incisors, 2 to 4 injections into the gums for molars. But if two teeth are destroyed, or the jaw is to be opened, the patient receives general anesthesia - he will sleep until the doctor finishes pulling out the tooth.
Features of pain relief for a tooth with a rotten root
An anesthetic injection is given at the site of the projection of the tooth roots. But if the medicine is injected into the rotten area, it may not work and the person will be hurt during the extraction process.
Treatment of patients with rotten roots is carried out in two stages. On the first visit, the dentist numbs the gum, prepares it and cleans it of pus. During the second visit, anesthesia is repeated, and the doctor removes the root that has rotted inside the gum.
Removal
The doctor decides how to remove a tooth if only the root remains. Usually they start with the use of forceps. Even if the destroyed roots remain under the gum, the holes do not completely heal - the dentist can carefully pick up the remnants of hard tissue and easily pull them out.
If the tooth has crumbled to the very base, it is pulled out with an elevator. Having inserted the instrument between the gum and dentin, the doctor presses on the handle and makes rotational movements of small amplitude. As a result, the periodontal fibers shift and the root is squeezed out of the socket.
A drill is used when it is necessary to crush the hard tissues of a molar before removal. With proper anesthesia, this procedure is painless; discomfort is possible only when the gums are already healing.
Relieving inflammation
When removing a rotten root, an inflammatory process is often detected. To ensure that the wound heals safely and does not fester, it is customary to treat it with an antiseptic. But one treatment will not provide adequate prevention, so an anti-inflammatory drug is placed in a fresh hole. With it, the hole will heal faster, and the patient will have less chance of developing alveolitis.
Stitching
To extract the root system, the doctor separates and lifts flaps of soft tissue; they can only be attached back by suturing. It is customary to tighten the edges of the holes with threads during double or triple removal, when a significant part of the gum has been subjected to preparation. This is done so that the affected area heals faster and does not cause discomfort to the patient.
Is it worth getting an implant?
The absence of the sixth tooth threatens:
- displacement of neighboring units;
- advancement of antagonists on the opposite jaw.
Neighboring and antagonist teeth will slowly shift, which threatens to expose the roots, the appearance of wedge-shaped defects at the gum itself, exposure of the neck, which is sensitive to changes in temperature of water and food, and pain. In addition, there will be a change in the bite, since the teeth will be out of place. Therefore, it is necessary to place an implant to maintain healthy teeth and correct bite.
Is it possible to remove it at home?
Removing a tooth on your own is dangerous; at home, it is difficult to ensure sterility, numb the gums, ensure that the root is completely pulled out, and prevent blood loss and other complications. You can remove only a very loose tooth yourself without risk to your health.
Typically, children's loose baby teeth are removed at home. It is important to remove food debris and thoroughly disinfect the oral cavity. You need to tightly grasp the tooth with your fingers wrapped in sterile gauze, loosen it well and only then pull it. If after the second attempt you are unable to pull out the tooth, entrust this difficult manipulation to an experienced dentist without risking your health.
If the tooth comes out of the socket easily, you need to press the gauze swab firmly onto the wound to stop the bleeding and hold it for 30-40 minutes. You should refrain from eating for two hours.
If any unpleasant discomfort occurs, it is advisable to consult a dentist as soon as possible to prevent complications from developing.
Finally, I would like to remind you: simple preventive measures will allow you to keep your smile snow-white and your teeth healthy and strong for many years.
Operation stages
The six implant is installed in the classical way, as for all other lost teeth. Includes stages:
Preparation
Identification of contraindications, assessment of bone tissue and study of its size and density. Sanitation of the oral cavity, removal of plaque, treatment of gums and adjacent teeth. The stage lasts from several days to a month.
Bone tissue augmentation
If necessary, it is carried out as a preliminary stage in case of lack of bone tissue. The operation lasts an hour. After the planted material has fused with the bone (4-5 months), the artificial roots themselves are installed.
Installation of implants
The gum is peeled off, a bed is formed in the bone, an implant is placed, a plug is fixed, and sutures are applied. On the lower jaw, the implant takes 2-4 months to take root, on the upper jaw - 4-6 months.
Temporary prosthetics
At the patient’s request, lightweight plastic removable Butterfly immediate dentures are installed, which are attached to adjacent teeth.
Permanent prosthetics
The implant is opened, the plug is removed, the gum former is fixed, and after 10-14 days the abutment is installed. Impressions are taken and crowns are installed.
The sixth tooth implant can be placed immediately after removal into the resulting socket, but with a sufficient amount of bone tissue and under the following conditions:
- a pre-planned operation with the possibility of conducting diagnostics and assessing the immediate installation of an implant;
- atraumatic removal without damaging the alveolar process;
- absence of inflammatory and purulent processes at the root.
Possible complications after tooth extraction
Complications can appear during surgery, as well as after it, and can be local or general. General: fainting, rarely – shock. Their cause is the patient’s psycho-emotional stress, sometimes pain due to poor-quality anesthesia.
Local complications:
- Fracture of the tooth being removed (crown or root);
- Dislocation or fracture of a nearby tooth;
- Trauma to the soft tissues of the oral cavity;
- Dislocation or fracture of the jaw;
- Perforation of the bottom of the paranasal sinus;
- Pushing the tooth root into the maxillary sinus;
- Bleeding;
- Alveolitis.
Features of implantation of the 6th lower tooth
The six of the lower jaw bears more loads during chewing than the upper jaw. Therefore, implants are selected taking this fact into account - wide and of sufficient length. The nuances of implantation from below:
- easier to carry out than on the top;
- implants take root faster - in 2-4 months, since the jawbone is denser and anatomically higher;
- but there is a risk of damage to the trigeminal nerve if the protocol is not followed, which is complicated by numbness of the chin and lips.
If the bone is small in height, then a preliminary operation is performed to increase it. The gum is peeled off, bone material is added, and a resorbable membrane is applied to secure it. Recovery takes up to six months.
Without preliminary bone grafting, surgery is possible if the atrophy is moderate. In this case, our Center uses bone growth stimulants. They are fixed to the neck of the artificial root during its installation and trigger the processes of bone tissue regeneration. In this case, implant healing and bone tissue growth occur simultaneously.
Who will have to part with a tooth?
Complications following tooth extraction in the doctor's office are extremely rare. Much more often, sad consequences occur when it spontaneously falls out due to destruction or injury. In such cases, there are two options: restoration of dentin and enamel or removal of the tooth root.
The tooth root will have to be removed if the following symptoms occur:
- constant discomfort in the gums;
- sharp pain when chewing;
- swollen soft tissue;
- bleeding;
- the appearance of pus.
A sure sign of an inflammatory process in the gums is an increase in body temperature in the absence of symptoms of another disease.
Important! You cannot postpone a visit to the dentist, even if only one of these symptoms appears. Any suspicion that the tooth root remains in the gum and has begun to rot should prompt an urgent visit to a doctor.
What are the roots of teeth, look at the photo:
Temporary contraindications
Surgical removal of the root of a decayed tooth is contraindicated during:
- relapse of complex mental disorder;
- acute phase of ARVI;
- exacerbation of neurological disease;
- rehabilitation after a heart attack.
Doctors at dental clinics are aware of all contraindications to extraction. But not all conditions have clear clinical signs, so in order to avoid unpleasant consequences, it is necessary to warn the doctor about the ailment.
Price
Our Center has a case payment system, which means that the case includes all materials and necessary manipulations.
The cost of implant installation includes:
- implant and superstructures;
- work of an implantologist;
- anesthesia;
- basic bone building complex;
- primary and repeat CT.
The price of implants varies depending on the type of bone. Nobel Biocare PMC (cheaper) is intended for weak tissue, and Nobel Biocare Conical Parallel CC (more expensive) is intended for dense tissue.
The cost of the crown includes:
- production of a prosthesis by a technician;
- taking impressions;
- installation of a crown.
Tooth extraction (for simultaneous implantation), bone grafting or sinus lifting are paid separately. Prices for services can be found here.
Indications and contraindications for molar tooth extraction
It is impossible to determine the indications for the removal of molars in absentia; this requires an examination by an experienced dentist. Recommendations for carrying out extraction are:
- purulent periostitis when it is impossible to drain exudate through the root canal, abscess, phlegmon;
- purulent-inflammatory periodontal diseases, cystic formations, the presence of a tumor;
- longitudinal axial fracture of the dental crown, pulp exposure;
- destruction of the crown, excluding its reconstruction;
- incorrect position of the tooth, as a result of which the mucous membrane is injured or it is impossible to install an orthopedic prosthesis;
- diseases in which destructive changes in bone tissue occur;
- advanced inflammation of the paranasal sinuses, sinusitis.
There are the following contraindications for removal:
- exacerbation of cardiovascular diseases (pre-infarction condition, angina pectoris, arrhythmia, hypertension);
- acute respiratory viral diseases (including influenza and sore throat);
- general diseases of the body (renal failure, pancreatitis, infectious hepatitis);
- damage to the nervous system;
- the presence of neoplasms, hemophilia, leukemia, radiation sickness;
- the first and last months of pregnancy;
- inflammatory dental diseases (gingivitis, stomatitis);
- exhaustion of the patient’s body, dystrophy;
- alcohol intoxication.
Only a doctor has the right to make a decision about removal, carefully weighing all the pros and cons.
Guarantees
In our Center, implants are installed with a lifetime warranty from the manufacturer - Nobel Biocare. We provide guarantees:
- lifetime for the installation of implants;
- 1 year for crowns.
The warranty program includes a complex for the implant, surgery, bone reconstruction and prosthetics.
The guarantee is valid provided that the patient follows the doctor’s recommendations, care rules and regularly visits the dentist.
What to do after deletion
After any surgical intervention, you should follow all the dentist’s recommendations, as well as:
- do not eat for 2 hours after the procedure;
- cool the soft tissues of the face in the projection of the removed root;
- stop smoking for two days;
- take prescribed pain medication;
- make antiseptic applications;
- watch to see if other teeth are crumbling.
Sometimes after complex extractions, dentists prescribe antibiotics to patients.
This appointment cannot be ignored - after a tooth is pulled out of the socket, a focus of infection forms in it, which can only be extinguished with the help of medications.
The following video schematically shows different methods for removing incisors, canines, molars and premolars of the lower and upper jaw.
Alternatives
An alternative method for restoring sixes is a bridge prosthesis. This is a structure consisting of crowns tightly connected to each other. To restore one tooth, the bridge consists of 3 crowns. The two outer ones are fixed on the teeth on both sides of the defect. The supporting teeth are ground down to form the internal cavity of the outer crowns of the prosthesis. The middle crown is hinged and imitates the lost six.
This option is cheaper than implantation, but has disadvantages - grinding the enamel of living teeth leads to a reduction in their service life. Another important point is that the bone under the hinged crown does not receive stress during chewing, so bone tissue atrophy is inevitable.
How to remove a rotten tooth root while preserving the crown
A tooth in which only the root remains is not always pulled out entirely. For example, if an inflammatory process develops at the root apex, but the tooth itself can still be saved, resection of the root apex is performed - partial removal.
The procedure is carried out after filling the canals, under local anesthesia. The operation is simple and lasts no more than half an hour. Its main stages:
- Anamnesis collection.
- Preparation of the surgical field.
- Anesthesia.
- Cutting the gum to access the root.
- Delamination of soft tissues.
- Sawing out a “window” in the bone.
- Cutting off the inflamed area of the root with a granuloma or cyst.
- Placing drugs into the cavity that stimulate bone growth.
- Stitching.
Impacted wisdom tooth
These are usually the hardest eights to remove out of all the others. We have already numbed the surgical field. What's next?
It's under the gum! So, we take a scalpel in our hands and make a delicate incision in the area of the tooth being removed. This creates access to the wisdom tooth being removed. It is isolated from the surrounding tissues using special instruments, and now we can visually assess its position and choose a removal technique.
If the tooth does not erupt, it means that something is preventing it. This “something” will also interfere with its removal, and this “something” could be a neighboring tooth, a bony protrusion, etc. However, you won’t also remove the seven to get to the wisdom tooth, right?
Special surgical tip for removing wisdom teeth. Rotates at the right frequency, provides the right torque, does not burn tissue or inflate emphysema. In surgery, we use only such devices.
Therefore, we divide the tooth into parts. Using a special tip with a cutter speed of 150,000 rpm - this is no longer a simple angle cutter, but not yet a turbine cutter. The latter, by the way, is highly undesirable to use for removing teeth, because at 500,000 rpm it is easy to burn everything with a hellish flame, and with air from the cooling nozzle you can also inflate emphysema over half your face. In general, for removal you need to choose the right tools; there are no trifles or compromises here and cannot be. And you should think a hundred times before removing such problematic teeth in a one-chair dental office at a rural club on the “Half-Empty Bins” collective farm.
Impacted teeth are removed mainly with an elevator, and not with forceps, as many are accustomed to thinking
So, we divide the tooth into 2-3 parts in order to remove it carefully and with little trauma to the surrounding tissues. And teeth are usually removed using an “elevator” (in the picture on the left). Forceps, which everyone associates with removal, are actually used extremely rarely.
Well, the tooth has been removed. Next, we clean the tooth socket from “sawdust” and small tooth fragments that might remain. Using a curette.
When removing wisdom teeth, no biomaterials are used; the hole is filled with a blood clot on its own, this is quite enough for normal healing.
Moreover, “pushing” biomaterials into the hole can complicate the healing process, so let the regeneration process take place naturally and simply, and not fancy, as some doctors suggest.
After removal, resorbable (absorbable) sutures are placed on the hole; most often they do not need to be removed.
The clot is in place. Next, we bring the edges of the wound together and put stitches so that food doesn’t get stuck in the wound, it doesn’t bleed too much, and it heals faster. But at the same time, the sutures should not be tight, because the wound may bleed significantly during the first 24 hours. And if you don’t create an outflow, edema often develops.
Why do you need to remove a cyst?
Patients sometimes do not want to resort to surgery, claiming that the tumor does not cause discomfort. Yes, the development of a cyst is asymptomatic. But it begins to destroy the root of the adjacent tooth, and then the surrounding tissue. And instead of timely basic surgery, you have to perform complex manipulations that threaten complications.
Another point:
If you do not remove the dental cyst while it is still forming (the cost will be determined by the attending physician), then there is a possibility of its degeneration into a malignant tumor.
Come for a consultation, and we will decide what steps you need to take specifically in your situation, whether you can save the tooth or need to remove it, we will take pictures to identify a cyst or granuloma. Fast, comfortable, pain-free.
