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Medical Forum / General / Dentistry / August 2007Fractured tooth with crown needs to be extracted, what to expect?
Greetings all, I have to get my previously crowned molar (#19) removed - it did have a root canal about 5 years ago. I developed an abscess recently and Endo tells me it is fractured. I've been on antibiotics for a week. Fortunately I am in no pain whatsoever. So, within the next two weeks or so I will have it removed. Are there any special issues with extractions on these crown teeth with root canals, and should this be generally painful afterwards? Also, will removal of that tooth generally effect speech? Thank you for any help! Matt Usually, an endo treated #19 will be very brittle and attempts at simple removal will result in multiple fractures of the roots, making the removal of all the fragments difficult with the possible loss of the buccal plate of bone. The safest way, after appropriate local anaesthesia, is to carefully remove (drill off) the crown. Once the crown is removed, a mini gingival flap can be made 360 degrees around the tooth - just enough to expose the area where the root trunk splits into the two roots. Then the trunk can be separated with the drill into two roots which can then be elevated and removed without problems. However in about 20% of these teeth, these separated roots are so brittle that they fracture anyway, requiring root tip elevators to coax the remnants out. After that, healing should be uneventful, although there is a higher incidence of dry socket in these endo treated teeth (anecdotal) than in non-endo treated teeth. If there is a chance that you will want to replace this tooth with an implant, you should have a socket preservation bone graft placed to insure that the buccal plate does not go through its normal post-extraction resorptive process. Of course, you are awake during the procedure if done by your GP. If you don't think you can stand for the manipulation, cracking sounds, tooth/bone smells, and drilling noises, you will need to see an oral surgeon to be consciously sedated. Viel Spass! >Usually, an endo treated #19 will be very brittle and attempts at simple >removal will result in multiple fractures of the roots, making the [quoted text clipped - 22 lines] > >Viel Spass! Thank you for the reply. You know, that isn't as enjoyable as I imagined but knowing these details helps me. Sounds like a job for an oral surgeon. I am leaning towards an implant and will discuss the bone graft before the extraction. Maybe I will leave the tooth in and see if it abscesses again.. Just Kidding! Seriously - thanks for the reply and take care. Matt Many general dentists are qualified to provide conscious sedation as well.... On 8/8/07 7:31 PM, in article f5kkb390rvf4mjti20q3l1mt1dq7kqp03i@4ax.com, >> Usually, an endo treated #19 will be very brittle and attempts at simple >> removal will result in multiple fractures of the roots, making the [quoted text clipped - 34 lines] > > Matt >Greetings all, > [quoted text clipped - 11 lines] > >Matt Think that Herr Dr is giving you a worst case scenario. It's not that terribly difficult to remove a tooth that has previous endodontic treatment. Good technic, skill, and experience are important. Your speech likely will not be affected. The extraction site should be no more painful than any other extraction. >> Greetings all, >> [quoted text clipped - 21 lines] > The extraction site should be no more painful than any > other extraction. I would only add that some thought should be given to if/when/how this tooth is to be replaced. If an implant is considered, an assessment of the extraction site's suitability for implant fixture placement should be done, and possibly a bone graft on the spot. Steve  SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 Thanks for the reply. I would like to get an implant, as the surrounding teeth are fine. I really do not want a bridge. My only apprehension is the $$$. I don't believe my dental insurance will cover the implant preparation. Which leads me to one more question if I may... Is it safe to assume a "standard" crown will be used on the implant? I ask because I my plan partially covers crowns, and I can't see any difference between mounting the crown on a natural tooth or implant on the benefit description. If I could get coverage for the crown I would be in much better shape! Thanks again! Take care, Matt >>> Greetings all, >>> [quoted text clipped - 28 lines] > >Steve Most plans will pay for a percentage of the CROWN which goes over the implant. Delta is now beginning to sell plans which cover some of the surgery. Signature/ Amatus / > Thanks for the reply. > [quoted text clipped - 49 lines] >> >>Steve Exactly! Let the person who will place the implant fixture remove the tooth. They can evaluate the bone at the time of extraction and may choose to place the implant right then. Or,,,,,,,,,,, they may choose to place some grafting material in to the fresh socket. Signature/ Amatus / >> >>> Greetings all, [quoted text clipped - 28 lines] > > Steve Another option is to apply PRP from the patients own plasma to preserve the ridge and enhance healing. Any of you guys ever use this technique? On 8/8/07 6:22 PM, in article dmrui.2437$mw4.1505@trndny09, "Mark & Steven Bornfeld" <bornfeldmung@dentaltwins.com> wrote: >>> Greetings all, >>> [quoted text clipped - 28 lines] > > Steve > Another option is to apply PRP from the patients own plasma to preserve the > ridge and enhance healing. > > Any of you guys ever use this technique? I leave all grafting procedures to my OMFS. Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 PRP or platelet rich plasma is a procedure that you can do in your office... It extracts cells from a blood sample that you place into the extraction site with a syringe, to promote bone formation. IT is not a bone graft per se... You have to be able to draw a sample in a vacutainer and spin it in a centrifuge. The whole process takes about 15 minutes. You also will have plasma clotting factors as a by product that are great for controlling post op hemorrhage.... On 8/9/07 8:49 AM, in article S3Eui.21238$ls4.3941@trndny07, "Mark & Steven Bornfeld" <bornfeldmung@dentaltwins.com> wrote: >> Another option is to apply PRP from the patients own plasma to preserve the >> ridge and enhance healing. [quoted text clipped - 4 lines] > > Steve Believability index is dropping. Signature/ Amatus / > Another option is to apply PRP from the patients own plasma to preserve > the [quoted text clipped - 41 lines] >> >> Steve Thank you. I appreciate the reply. I certainly hope it isn't that bad! Take care, Matt >>Greetings all, >> [quoted text clipped - 21 lines] >The extraction site should be no more painful than any >other extraction. Really, Newbie, you are a load. Obviously, you ain't been removing these teeth for 30 years. You also don't like my IA nerve damage analogy to a physician killing a patient. I've been watching your posts for a year and you a quite an arrogant SOB. I guess you have NEVER made a dental Tx mistake. You should be teaching in a dental school. I'm sure PENN or NYU would love to have you. I think his remark on the difficulty of that extraction is right on. Newbie (Henry) and I each have over 20 years in the field. We have removed enough teeth in our life's to fill a shopping bag. Everyone's typing style reflects a different image. I have visited Henry's office IRL. You are way off the mark. Signature/ Amatus / > Really, Newbie, you are a load. Obviously, you ain't been removing these > teeth for 30 years. You also don't like my IA nerve damage analogy to a > physician killing a patient. I've been watching your posts for a year and > you a quite an arrogant SOB. I guess you have NEVER made a dental Tx > mistake. You should be teaching in a dental school. I'm sure PENN or NYU > would love to have you. Almost got that 55 gal. drum out back filled ! ;-) Rock-on, Billy Wayne. >I think his remark on the difficulty of that extraction is right on. Newbie >(Henry) and I each have over 20 years in the field. We have removed enough [quoted text clipped - 8 lines] >> mistake. You should be teaching in a dental school. I'm sure PENN or NYU >> would love to have you. >Really, Newbie, you are a load. Obviously, you ain't been removing these >teeth for 30 years. You are right, it's only been a paltry 23 years. Ahh, the personal attack, the last bastion of those who cannot win an debate on merit and facts. >You also don't like my IA nerve damage analogy to a >physician killing a patient. Because it was ludicrous. Peripheral nerves can heal. And unless you are Jesus, don't think you can raise the dead. > I've been watching your posts for a year >and you a quite an arrogant SOB. The psychiatrists call that projection. Whoops, your unwarranted assumption of german superiority is showing. >I guess you have NEVER made a dental Tx mistake. Never had to sacrifice a buccal plate to get a tooth out. > You should be teaching in a dental school. I'm sure PENN or NYU >would love to have you. Wouldn't want to take the pay cut. Besides, am quite content here in Nevada. BTW you might have better luck if you tossed the Black & Decker, and bought something more suitable for dental treatment. Recommend the NSK AK455L Ti-Max *handpiece*. >> Really, Newbie, you are a load. Obviously, you ain't been removing these >> teeth for 30 years. [quoted text clipped - 24 lines] > Wouldn't want to take the pay cut. > Besides, am quite content here in Nevada. Are you in the witness protection program? Steve > BTW you might have better luck if you tossed the Black & Decker, > and bought something more suitable for dental treatment. > Recommend the NSK AK455L Ti-Max *handpiece*. SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 >> Wouldn't want to take the pay cut. >> Besides, am quite content here in Nevada. > > Are you in the witness protection program? > >Steve Yeah, had to go back into the system. The facelift didn't throw them. Ah, Nevada. Now that's a place with a lot of "honesty". Actually, Henry is in central Idaho. I have been to his office. I happily let him work on my mouth while I was there. Signature/ Amatus / > Ah, Nevada. Now that's a place with a lot of "honesty". Good fur U. I'm shuah it was gratis or at a reduced fee & I'm shuah he is a gr8 dentist but he suks as a caring person. IMHO. You have to look past the "coldness" of typed messages sent quickly between patients. Easy to get the wrong impression. Your posts don't always come out sounding "happy and thoughtful" each time. I know mine sometimes appear callous or dis-interested as well. For instance, I don't know too many periodontists around here who will offer as much advice about work they have not performed for 19 years. BTW, why the German screen name and email address? I doubt they have Comcast ISP in Germany.. Signature/ Amatus / > Good fur U. I'm shuah it was gratis or at a reduced fee & I'm shuah he is > a gr8 dentist but he suks as a caring person. IMHO. A correctly made crown prep is just as important to a periodontist who has not done them (family and friends don't count?)in 19 years as they were when practicing GD. All the factors are still there in evaluating a tooth that "should have had a crown lengthening" as to a virgin tooth with perio disease. Geeze, I can get that impression. If I try to send this guy out for a CCL, maybe he won't do the crown at all. Hmm, lets see if I can get by without it. Sound familiar? It is fun to watch youse guys go to extremes to find out who's posting. Do you have my real name, too? Vieleicht you could post that. Trudy would like to see that. >A correctly made crown prep is just as important to a periodontist who >has not done them (family and friends don't count?)in 19 years as they >were when practicing GD. All the factors are still there in evaluating a >tooth that "should have had a crown lengthening" as to a virgin tooth >with perio disease. OK, finally you are starting to state your case. Have no difficulty performing crown lengthening when indicated. Single tooth, or maybe two bridge abutments, maybe more. Can also do CL in the prep phase, place a provisional, and make the impression after healing. >Geeze, I can get that impression. If I try to send this guy out for a >CCL, maybe he won't do the crown at all. Hmm, lets see if I can get by >without it. Sound familiar? Not really to me, but can understand why you may see this in your practice. For a bicuspid or a molar tooth why not teach your GP's how to do this simple procedure ? Then you don't have to try to fix it and make excuses later. In the esthetic zone, PerioD is da man! >It is fun to watch youse guys go to extremes to find out who's posting. "Youse guys" ? Faking NYC ? hmm... Extremes ? only takes hitting the 'h' key to view all headers. >Do you have my real name, too? Vieleicht you could post that. Trudy >would like to see that. Yeah sure, vielleicht nicht. If you want to reveal your real name, go ahead. If you don't, so what ? It matters not malasuerte. Who is Trudy ? Don't need your actual name. Just find it interesting that you choose a German screen name and email address, but don't seem to be on that side of the pond. I would have thought you would have said something about heritage, or having done military service, or just thought it made for a fun "handle". I think it is fun to hear why certain screen names are chosen. I suspect it just that fact that we are typing short responses, but it sounds like you have little respect for the GP. :-) <smile> Signature/ Amatus / >A correctly made crown prep is just as important to a periodontist who has >not done them (family and friends don't count?)in 19 years as they were [quoted text clipped - 9 lines] > you have my real name, too? Vieleicht you could post that. Trudy would > like to see that. >Good fur U. I'm shuah it was gratis or at a reduced fee & I'm shuah he >is a gr8 dentist but he suks as a caring person. IMHO. There you go with that projection thingy again. Nope not free, it cost him a plane ticket plus a sandwich, soda, and pickle at the local general store. And, I bought that cool baseball hat !!! Signature/ Amatus / > >>Good fur U. I'm shuah it was gratis or at a reduced fee & I'm shuah he [quoted text clipped - 4 lines] > Nope not free, it cost him a plane ticket plus a sandwich, > soda, and pickle at the local general store. BTW,,,,,,,,,,, Strad stole that hat from me. It is now part of his hat collection. He liked the "Camo" - look. Signature/ Amatus / > And, I bought that cool baseball hat !!! > [quoted text clipped - 5 lines] >> Nope not free, it cost him a plane ticket plus a sandwich, >> soda, and pickle at the local general store. The hat completely slipped my mind. The first night's dinner and that fine bottle, though long gone, are *not* forgotten. ; ) >BTW,,,,,,,,,,, Strad stole that hat from me. It is now part of his hat >collection. He liked the "Camo" - look. > >> And, I bought that cool baseball hat !!! ditto Signature/ Amatus / > > The hat completely slipped my mind. [quoted text clipped - 6 lines] >> >>> And, I bought that cool baseball hat !!! And I have actually been to AC's office in Wyoming. In fact am still trying to get enough time to visit again. >Actually, Henry is in central Idaho. I have been to his office. I happily >let him work on my mouth while I was there. > >> Ah, Nevada. Now that's a place with a lot of "honesty". |
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