Ever wondered how far can we save your tooth? Well, pretty much really far.
This is a case where decay has badly broken down all of the coronal or top part of the tooth. Only the root of the tooth or part of the tooth that is usually submerged under the gums and bone is left.
Usually, people with this kind of case come in wanting an extraction. And us being dentists, we offer the most conservative and simple approach first. And looking at the picture, you might have figured out that the patient and I eventually chose to save the tooth and give it another chance.
There are numerous instances and procedures that this case can be approached. The easiest will be surgical procedures like extraction and placing of a dental implant as the final replacement of the tooth loss.
A dental extraction is a procedure wherein you remove the tooth along with its infection. A dental implant, on the other hand, is a screw-like fixture drilled within a bone and replaces the extracted tooth. These procedures may seem cheaper at first because the extraction or the first part of the treatment is relatively cheap, but in the long run, the dental implant price is way higher than getting root canal treatment. There are even times that a dental bone graft will be required for bigger chances of recovery and success if there is no sufficient bone to support the dental implant.
Dental Implant, generally, is still a conservative approach when talking about tooth replacements. But in this case, where there is still part of the natural tooth left, and it is still intact in the bone, the more conservative decision is to retain the tooth.
Cases like this usually involve infection underneath the tooth on its very tip. That is what we usually aim to remove before any final restorations or making the final replica of the tooth like dental crowns.
This case underwent Root Canal Treatment (RCT). This procedure removes the infection beneath the tooth without having to resort to the removal of the hard tooth structures. These hard tooth structures will be used as the base of the final restoration or crown.
RCT also includes the removal of the infected pulp. The pulp is a part of the tooth made up of nerves and blood vessels located at the very core that gives life and nourishment to the tooth.
This procedure is also done under anaesthesia or by numbing the area. Although this tooth is already dead and won't feel sensitivity because the pulp that is responsible for the sensation of the tooth is already dead, numbing the surrounding area where there is still sensation like the gums, will help the patient feel comfortable during the procedure.
Restoring and copying the original tooth is not as easy as topping it with a crown. We still had to put a Fiber Post inside for added retention. A Fiber Post is literally a material made of fiber/glass/silica that we stick in the core of the tooth that extends outward. It's like an extension for us to be able to build around using composite or dental filling material where the dental crown will sit.
But that's not the final step before we start putting the final dental crown, we will still need enough natural tooth surface outside the gums and bone for the crown to safely sit. and as you can see in this case, all tooth structures left is totally submerged inside the bone. This will mean that we have to decide whether we cut the gums and the bone surgically or gradually pull the tooth upward using braces or orthodontics.
This specific case already has a lot going on, and one of the problems is the bite. This patient will eventually get braces or orthodontic treatment to correct the deep bite. That being in mind, the decision that the patient and I agreed on to maximize the orthodontic treatment and try to save money is by pulling the tooth outward until enough tooth needed for the dental crown is exposed. This is also the reason why we only used a temporary or plastic crown (as seen on the photo set), to be able to stick the brackets.
As dentists, our first thought is never to say die. We will always try to save the tooth, but the final decision will always be from the patient. And like all sciences, we are ever-evolving and there is no same case and there will be instances of success and failure. But as long as there is proper planning and compliance in following instructions, you will surely have a big success rate waiting for you.
Well, that's it about this case, I hope you learned and enjoyed this as much as I did doing the case and writing this blog. I try to make the explanation as simple as I could for the general public to be able to enjoy and understand it too, if there are certain areas that still confuse you or you want a deeper understanding, you may email me at dr.rafaelle@gmail.com. If you have questions regarding your personal case, I am more than happy to give you a consultation, just book an appointment with us via email, contact number, or through this link: Book an Appointment.
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