Conservative dental treatments are not always successful in solving patients’ dental problems.
No matter how much they try to repair everything that is damaged by restoring and restoring the integrity of dental structures, sometimes doctors have to resort to radical methods.
Of these radical methods, the best known are the following:
Tooth extraction – is the unpleasant situation when a tooth can no longer be maintained at the level of the dental arches.
This unfortunate situation occurs when the tooth is compromised. Either the carious destruction has been sufficiently extensive and deep that the tooth is no longer prognostic to be maintained in the dental arches, or as a result of trauma the tooth is unrecoverable.
Another situation requiring tooth extraction concerns units that are affected by periodontal disease. Periodontal disease occurs as a result of increased deposits of bacterial plaque, which generate gingivitis. This condition, left untreated, can lead to increased bacteremia, which can spread to the bone, which reacts by resorption.
Once the bone is resorbed, the tooth will have less and less room to implant and tooth mobility will occur. This process of bone resorption is irreversible and, undiagnosed and unchecked, will eventually lead to early tooth loss.
Premolarization – is performed when a molar has one or two of its roots that can be preserved and another one that is completely destroyed, with an indication for extraction. In order to preserve as much of the tooth as possible, Premolarization, i.e. the preservation of the salvageable roots and the extraction of those without restorative potential, will be used.
In this way, a premolar tooth will be obtained from a molar which will be used in a subsequent prosthetic plan.
Coronal elongation is one of the artificial procedures that the dentist sometimes resorts to, as it is a microsurgical procedure and the main aesthetic purpose.
Also, some prosthetic work or fillings cannot always be applied without this procedure.
The aim of coronal elongation is to harmonize the gingival contour and increase the visible coronal surface of the tooth. This helps remove excess gum tissue and will automatically lead to a more beautiful smile.
The procedure itself is not very time-consuming and can be done in a single session. It is up to the doctor to decide whether only gum tissue will be removed or if further bone remodeling is needed.
Operculectomy
Operculectomy is a minimally invasive surgical procedure aimed at aiding the complete eruption of the wisdom tooth. This procedure involves preserving the wisdom tooth within the dental arches and can only be performed under two conditions:
The wisdom tooth in question must be covered only by gum tissue. Wisdom teeth can be fully impacted, when they are completely covered by bone, or partially impacted, when they have a gum flap on the surface that prevents their eruption. Only in the second case, when the wisdom tooth is covered by gum tissue, can operculectomy be performed.
Tooth replantation
Tooth avulsion is the complete displacement of the tooth from the dental socket as a result of trauma and is a medical emergency.
It must be recognized and requires prompt intervention to minimize the negative effects on the patient’s dentition.
In the case of trauma resulting in the avulsion of a permanent tooth, rapid action must be taken, within the first 20-40 minutes the tooth must be repositioned in the socket for the best prognosis.
The fallen permanent tooth should be gently rinsed with plenty of saline solution, taking care not to damage the root surface which may have live fibers and periodontal cells.
Once the tooth and the oral cavity are cleaned, an attempt can be made to reimplant the tooth in its original position in the alveolar bone, which will then be held in place with a flexible splint for two weeks.
If indicated, root canal treatment of the avulsed tooth will be carried out 7-10 days after reimplantation with a calcium hydroxide medicament for one month, after which root canal treatment with a compatible material will be completed.
If the tooth is temporary, it is not recommended to re-implant it, as it may negatively influence the growth of the permanent tooth.
The dentist will prescribe a systemic antibiotic, and in addition, as recommended in all dental trauma, good oral hygiene with mouthwash containing 0.12% chlorhexidine twice a day for a week, cleaning the teeth with a soft-filament toothbrush, a light diet and avoiding smoking for several days, thus providing favorable conditions for the regeneration of periodontal ligaments.
Apical resection – is a surgical procedure that involves severing the tip of one or more tooth roots, followed by sealing the root canal. An apical resection is performed when infection at the tip of a root cannot be treated by either endodontic treatment or retreatment.
In order to save the tooth from extraction, only the portion affected by the infectious process will be severed.
The indications for apical resection are as follows:
The canal cannot be obturated along its entire length. Either calcifications have occurred or there are obstacles that cannot be overcome in the apical third of the root canal, if these prevent the obturation of the root canal along its entire working length, apical resection of the root tip is indicated.
Curved canals – canal and root anatomy is varied and in some situations of extreme curvatures, the only plausible solution is to perform an apical resection, provided the curvature cannot be overcome and endodontic treatment completed appropriately.
The apical resection is a surgical intervention that is performed under local anesthesia, an incision will be made in the gum, in the gingiva, in the area of the problem root and with the help of the drill, the bone will be removed to create a hole to reach the infected site. After removing the infection and a portion of the tooth root, the canals will be cleaned and sealed, the gum repositioned and sutured. The sutures will be removed 7-10 days postoperatively.
