Tooth extraction

Regular dental checkups are crucial for monitoring the alignment and positioning of teeth, particularly in children and adolescents during their growth phase. These appointments also provide an opportunity for the specialist to assess the condition and functionality of fixed wire retainers, ensuring they remain effective over time.

Tooth extraction

Extracting a devitalized tooth may seem contradictory, as root canal treatment is typically performed to save the tooth and avoid its removal. However, there are specific cases where keeping the tooth in the mouth poses risks or even dangers to oral health, making complete removal necessary.  

Dentists usually prioritize a conservative approach and only resort to extraction when other treatments prove ineffective.  

Let’s explore situations where a tooth can be preserved, thanks to advancements in modern dentistry that offer various techniques to achieve successful outcomes. We will also examine cases where extraction is the best option and may require the placement of a prosthesis, particularly when decay or damage is too extensive for recovery.  

What does devitalization involve?

Devitalization is a procedure designed to save a damaged tooth, either by repairing it or using a filling. It typically begins with a decayed tooth, often featuring a cavity that can range in size and is usually located in the central or lateral areas of the tooth.  

The first step in addressing decay is through a simple filling, which halts the progression of the cavity. However, regular monitoring is essential to ensure the condition does not worsen.  

Regardless of the extent of pulp damage, a conservative approach is always preferred before considering tooth extraction. This may include reconstructing a portion of the tooth if it has chipped, with the goal of restoring its original function and preventing decay from progressing to the point of tooth loss.  

A devitalized tooth often requires encapsulation to protect it from external factors such as impacts, friction, and food particles. This protective measure helps the tooth remain durable over time while blending aesthetically with the rest of the dentition.  

Devitalization involves treating the tooth down to its root and nerves, effectively eliminating the infection. If necessary, this may include root canal therapy to fully address the problem.

When devitalization is sufficient

In many cases, patients become aware of an infection only when the pain becomes severe and symptoms become noticeable. The key factor in deciding between devitalization and extraction is the extent of the infection and the areas it has affected.  

Tooth preservation is often possible even in cases of abscesses, provided the affected area is not too extensive and the pulp and surrounding structures remain viable. For most cases of decay, a conservative approach is preferred, as advancements in dentistry have made it possible to effectively treat even deep infections.  

Teeth suitable for encapsulation are typically left in place and protected with a crown, as they pose no harm to the dental arch and can be preserved. This approach avoids the need for dentures, which can be costly and inconvenient. Whenever feasible, a tooth stump is used as a foundation for reconstruction, provided it is structurally sound.  

When extraction is necessary

In certain cases, devitalization is either not recommended or only partially effective, making extraction the most practical solution.  

One such instance is severe tooth crowding, where multiple teeth are concentrated in a single area, overlapping and unable to be corrected with traditional braces. Extraction in these cases creates the necessary space for proper alignment and growth. Before proceeding, an orthopanoramic x-ray is essential to assess the gum’s internal structure and plan a minimally invasive approach.  

Other situations include advanced caries or pulpitis that are diagnosed too late for traditional conservative treatments to be effective. In these cases, extraction is required to eliminate the issue and prevent damage to adjacent teeth.  

Additionally, some patients develop large granular cysts that cannot be removed laterally. These cases may necessitate the extraction of one or more overlying teeth, which can then be replaced with a prosthesis. As always, instrumental examinations guide the specialist in determining the least invasive and most effective strategy to preserve as many teeth as possible.  

When extraction is necessary for children and adolescents  

Children and adolescents are particularly prone to developing impacted teeth—teeth that fail to erupt properly and become stuck in positions that harm other teeth and disrupt the smile. These teeth must be removed to create space and improve alignment, often with the help of braces in order to correct the bite and straighten the teeth.  

A more severe oral condition is pyorrhea, which causes gum deterioration and can lead to tooth loss. In conjunction with appropriate treatment, teeth that are loose and severely compromised in both root and enamel may need to be extracted.  

Additionally, patients undergoing certain types of radiation therapy or chemotherapy may require tooth extraction for medical reasons related to their treatment.  

Wisdom tooth extraction 

Wisdom teeth are the only teeth that are not devitalized but extracted immediately when infected. These teeth serve no functional purpose. For some individuals, they fully erupt, while for others, they remain within the gum and may become impacted.  

The extraction procedure involves complete removal of the tooth, guided by orthopanoramic imaging to assess its position relative to the dental arch and underlying nerves, ensuring a safe and effective process.  

Preventing tooth extraction through proper maintenance  

To avoid the extraction of a devitalized tooth as a last resort, proper dental maintenance is crucial. Key steps include:  

- Brushing teeth three times a day for at least two minutes.  

- Flossing to clean between teeth.  

- Attending regular dental checkups or seeking prompt care for any sudden pain or discomfort.  

If swelling or pain occurs, it is important to consult a dentist immediately, as these symptoms often indicate an infection. If untreated, the condition may worsen, rendering fillings or devitalization ineffective and requiring extraction.  

By following preventive measures, undergoing recommended diagnostic tests, and allowing the dentist to choose the least invasive treatment plan, patients can significantly reduce the likelihood of needing a tooth extraction.