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Medical Forum / General / Dentistry / December 2004Extraction of #5
I had #5 extracted with Novocaine.. Injections to roof and gums.. Same day I felt a split second tingling (felt like a nerve by the front of tooth #23 or maybe #22(lower left close to the middle of my mouth. I know that this has to be connected. The tingling is not painful and today is my second day and it feels as if it has gotten weaker although I still feel it... Not pain..just a nerve feeling. Tell me that these are connected. Thanks, Ken > I had #5 extracted with Novocaine.. Injections to roof and gums.. Same day I > felt a split second tingling (felt like a nerve by the front of tooth #23 or [quoted text clipped - 6 lines] > > Thanks, Ken Can't see how, unless the dentist used the extraction technique perfected by W.C. Fields in that old movie. Steve  SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 >> Tell me that these are connected. >> [quoted text clipped - 4 lines] > >Steve Maybe it was the Howard, Fine, Howard techic. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com >I had #5 extracted with Novocaine.. Injections to roof and gums.. Same day I >felt a split second tingling (felt like a nerve by the front of tooth #23 or [quoted text clipped - 6 lines] > >Thanks, Ken These are connected. Joel, you are serious...not just punning. I have a story to tell you about the implant process at another time though Thanks, Ken > >I had #5 extracted with Novocaine.. Injections to roof and gums.. Same day I > >felt a split second tingling (felt like a nerve by the front of tooth #23 or [quoted text clipped - 8 lines] > > These are connected. They are connected by skin, lips, cheeks, mucosa, blood vessels, etc. Signature~+--~+--~+--~+--~+-- Stephen Mancuso, D.D.S. Troy, Michigan, USA .................................................... This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ...................... > Joel, you are serious...not just punning. I have a story to tell you > about [quoted text clipped - 19 lines] >> >> These are connected. So Steve, injections given for #5 removal can effect another region of mouth, i.e.nerves sensations around #23. thanks, Ken > They are connected by skin, lips, cheeks, mucosa, blood vessels, etc. > [quoted text clipped - 33 lines] > >> > >> These are connected. >So Steve, injections given for #5 removal can effect another region of >mouth, i.e.nerves sensations around #23. > >thanks, Ken No. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com >>So Steve, injections given for #5 removal can effect another region of >>mouth, i.e.nerves sensations around #23. >> >>thanks, Ken > >No. - - - - - -> http://www.bartleby.com/107/Images/large/image778.gif No way, but they are connected via the body <g> Signature~+--~+--~+--~+--~+-- Stephen Mancuso, D.D.S. Troy, Michigan, USA .................................................... This posting is intended for informational or conversational purposes only. Always seek the opinion of a licensed dental professional before acting on the advice or opinion expressed here. Only a dentist who has examined you in person can diagnose your problems and make decisions which will affect your health. ...................... > So Steve, injections given for #5 removal can effect another region of > mouth, i.e.nerves sensations around #23. [quoted text clipped - 44 lines] >> >> >> >> These are connected. >No way, > > but they are connected via the body <g> - - - - - - - -> http://www.bartleby.com/107/Images/large/image778.gif >They are connected by skin, lips, cheeks, mucosa, blood vessels, etc. .... and more! How uncanny Today I did an extraction on a long curved RCTed decayed #5 root. Got it out in one piece took me about 5min, for awhile there I through I'd not be able to preserve the crestal bone. I was going to place a 4.3 by 16mm implant but discovered a buccal dishesence near the apex of the socket, so I ended up grafting and delaying placement for 6 months. > How uncanny > Today I did an extraction on a long curved RCTed decayed #5 root. Got [quoted text clipped - 3 lines] > dishesence near the apex of the socket, so I ended up grafting and > delaying placement for 6 months. When I had my #5 extracted I was told that an impant could not be done until the socket healed. How could you have done a 4.3 16MM implant at the same time as the extraction. Ken You can do this as immediate placement it is done all the time. I could show you videos of the surgeries. Ofcourse every situation is different and yours may have been compromised for this not to work and perhaps that was the reason it was not offered to you. I did not do it in this case because I discovered that the tip of the root was perforating the bone and this patient had a chronic infection there that created this opening. All of this compromises healing. There are people who will graft that hole right after placing the implant. I did not want to deal with the possible complications so I decided to place the implant after the graft heals 6 months. When I place my implants I like to make sure that puppy is nice and snug between the bone 360 degrees. > You can do this as immediate placement it is done all the time. I could > show you videos of the surgeries. [quoted text clipped - 9 lines] > place my implants I like to make sure that puppy is nice and snug > between the bone 360 degrees. I mentioned this to my dentist and he said that he likes to wait 2 months or so for the socket to heal before he does an implant. Does this make sense, It sounds like he is being conservative. Does it cause a problem if I have the graft done at the same time that he does the sinus lift (assuming that the latter is necessary). Is a sinus lift done more often than not..is it usually routine? Thank you for your advice Ken in the old days of implants, sinus lifts were not done. Implants were not presented as options for these locations. As more and more implants were placed dentists started to push the envelope try new things to accomodate peaple that could not get bridge work or dentures. As a result sinus lifts were attempted and now we can place implants anywhere. It does sound that your dentist is more conservative and cautious. It is OK to wait and now that the tooth is out, you might as well wait. But because the socket was not grafted it will cause the ridge width to shrink. Ultimately when the implant is placed you may never notice the difference and you will not have anything to compare it to. I'm sure your dentist has his technique as I or any other dentist have ours, but in my opinion waiting 2 months for an ungrafted extraction socket to shrink and lose width and height, is a compromise. > Ken in the old days of implants, > sinus lifts were not done. Implants were not presented as options for [quoted text clipped - 11 lines] > ours, but in my opinion waiting 2 months for an ungrafted extraction > socket to shrink and lose width and height, is a compromise. Very well put... I had the extraction on Tues..Do you see any problem if I go back this week and have the graft done to the socket. You are proabably correct in that I should have had it done at the time of extraction but I wasn't sure to go bridge of implant..although my dentist did say that it would shape the ridge better regardless. My time line was a concern since these are visible #5 and #4 teeth and I don't know if I want to wait that long. 2 months socket heal 5 months sinus lift(if necessary depending upon xray) 3-5 month implant placement 1-2 months abut Does this sound about right thanks again, Ken If it was Tuesday, You could go back to have the socket rescraped particulate bone packed and a membrane placed and sutured. You want to make sure your dentist does this kind of thing or you may need to see a periodontist. The later might be more expensive now. The other thing to keep in mind it will screw up your timeline, (i am not sure yout timeline is correct you want the implant to osseointergrate minimum 3-4 months not 1-2) after the graft you would wait 4-6 months then do implant and if needed sinus lift at same time. then in 3-4 months you can load the implant. For the healing abutment, if the implant was done as one stage surgery you may not have to wait very long for the tissue to heal. If it was 2 stage and there is some tissue work needed it could take a bit longer for the permanent crown but you will have a temporary crown during the healing process. Also there are some high end implants that work well in these areas check out on the internet the Nobel Perfect implant made by nobel biocare. Let me explain something. When you pay say $1500 for an implant placement surgery the actual cost of the implant fixture is around $300 and typically more than one is ordered to make sure a selection is available during surgery, the rest of the cost is the other materials doctors time etc... and later on there are other parts such as abutments and screws lab analogs, impression copings etc... The Nobel Perfect implant is more like a natural tooth and it costs about $500 for the fixture and it requires it's own surgical kit which can be borrowed from the rep. I do not know which kit your surgeon uses or your dentist likes, but these are other issues to consider. I am not saying the other systems do not work or that you can not get similar results and frankly if you say the socket was compromised during extraction, it may not matter, but it is an option to you. > If it was Tuesday, You could go back to have the socket rescraped > particulate bone packed and a membrane placed and sutured. [quoted text clipped - 28 lines] > results and frankly if you say the socket was compromised during > extraction, it may not matter, but it is an option to you. What is the purpose of the particulate bone packed at tme of extraction and the graft done during a sinus lift (if the latter is required). I thought the graft done during a SL is to ensure there is enough bone for impant ti be set into. If that is the case, what is the function of the socket graft done at the time of extraction. Thanks, Ken > What is the purpose of the particulate bone packed at tme of extraction and > the graft done during a sinus lift (if the latter is required). I thought [quoted text clipped - 3 lines] > > Thanks, Ken Ken, The purpose on the socket being grafted at time of extraction is to prevent the ridge or surrounding bone from shrinking to fill in the socket space. When you take the tooth out you are left with a hole the quantity of bone does not significantly increase during healing, the bone just resorbs and things get smoothed down thus reducing the width of the ridge available for a particular diameter of an implant. Ideally you want an implant with the same diameter as the tooth it is replacing, if the ridge gets narrower you either have to go with a smaller diameter implant (if one is available) or do some sort of block graft or ridge expansion and graft procedure. It is much easier to fill the socket with bone to avoid this. If the root of the tooth has a decent length and it was not in the sinus, you do not need a sinus lift. If there is inadequate height of bone left meaning to fully place the implant part of it will be in the sinus then you need to do a sinus lift and graft bone there so that the implant is covered with bone all over including in the sinus. A block graft means you cut a square piece of bone from somewhere else in the body (hip(iliac crest), chin, or ramus (back part of the jaw)) reshape it and drill holes in the ridge for blood supply and attach this bone with stainless steel screws and let it heal. The block graft does not do anything if there is not enough ridge height so you may still need Sinus lift. Ridge expansion means a cut is made to split the ridge. The ridge is wedged appart with a chissel and hammer and the implant is placed. The cracks are sometimes filled with bone and everything is left to heal. This procedure also does not do anything about ridge height so if sinus lift may still be required and would have to be done first as a separate procedure. Serious. They are connected. You may want to look here and follow the path through the semilunar ganglion (a connection point of nerves). http://www.bartleby.com/107/Images/large/image778.gif Joel M. Eichen DDS >Joel, you are serious...not just punning. I have a story to tell you about >the implant process at another time though [quoted text clipped - 17 lines] >> >> These are connected. >Tell me that these are connected. No, because they are not. >Thanks, Ken -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com >>Tell me that these are connected. > >No, because they are not. - - - - > http://www.bartleby.com/107/Images/large/image778.gif >>Thanks, Ken >I had #5 extracted with Novocaine.. Injections to roof and gums.. Same day I >felt a split second tingling (felt like a nerve by the front of tooth #23 or [quoted text clipped - 6 lines] > >Thanks, Ken Explanation for referred pain ........ (TEST WILL BE NEXT TUESDAY!) ** The graphic on the right shows the rough anatomy of the Trigeminal nerve on one side of the head. It is called the Trigeminal because it is actually one nerve that splits into three main branches to give enervation to one entire side of the face. All the cell bodies of the nerves that go to your teeth actually lie in two masses called the Gasserian (Semilunar) ganglia. It is this ganglion that splits into the three branches of the Trigeminal nerve. These ganglia are located under the skull, one in front of each ear. Each nerve cell (neuron) within the ganglion sends out a long, microscopically thin extension called an axon. The axon extends all the way from the ganglion into its target tooth. The left hand image shows small bundles of nerve cell axons leaving the tooth to join nerve trunks. The centered image below is a rather rough representation of how individual axons combine within several layers of connective tissue sheaths to form larger nerve bundles. These in turn combine to form nerve trunks. Note that even within the nerve trunks, each individual axon retains its separate identity, thus traveling all the way from the tooth to its cell body in the ganglion on that side of the head. Inflammation in the nerve of a tooth will often diffuse along the blood vessels and connective tissue of the nerve trunk making it difficult for anesthesia to penetrate into nerve bundles even at points relatively far removed from the actual site of the toothache. It is easy to see why producing good anesthesia may be quite tricky if the patient puts off coming in for treatment until the inflammation has gotten out of hand. The detail on the right is a representation of the fine anatomy of a nerve bundle as it enters into the apex (the tip) of the root of a lower front tooth. Note the extent to which it branches again and again inside the tooth. As the nerve bundle enters into the root, it is composed of thousands of individual axons, each one representing a separate neuron (nerve cell). Remember that these neurons actually live well outside of the tooth itself in the Gasserian ganglion on one side of the head. Each branch contains fewer and fewer axons until the branches become so fine that each one represents a separate axon from an individual neuron. The best way to avoid the (rare) horror show is to be treated when you first feel the pain. Normal toothaches with moderate pain numb out just as easily as any healthy tissue. If your dentist notes something on an x-ray and recommends that you have a filling or a root canal, don't put it off until it hurts. If you wait until you have acute pain or an abscess, even touching the tooth is painful and getting you numb may be difficult, especially if you are swollen. (Note that if the pulp is entirely dead in a tooth, and there is no pain, the tooth is simply an empty tube that happens to be filled with dead tissue, and the root canal can be done from beginning to end without any shots at all.) |
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