Diseased teeth: save or remove

Which Teeth Cannot Be Saved: From Extraction to Preservation

In dentistry, you often hear the phrase, "The tooth can't be saved; it has to be extracted." However, this is not always true. Modern techniques can preserve even teeth that seem hopeless at first glance. In this article, we'll explore which teeth are most often subject to extraction, which can still be saved, and how to correctly punctuate the phrase "extraction versus treatment."

Teeth Subject to Extraction: Causes and Conditions

1. Chronic Inflammatory Processes The most common reason for tooth extraction is chronic inflammatory processes such as periodontitis, cysts, and granulomas. A cyst larger than 1 cm is considered large and typically requires extraction. For clarification:

   • Granuloma: Inflammation about 0.5 cm in size.
   • Cystogranuloma: Inflammation up to 1 cm.
   • Cyst: Inflammation larger than 1 cm.

2. Broken Instruments If an instrument breaks off in the root of a tooth and cannot be removed or bypassed during canal obturation (filling), it can lead to continued inflammation and ultimately tooth extraction. Attempts to extract the instrument often damage the root, causing cracks and fractures.

3. Destruction of the Crown Portion Teeth where the crown portion is destroyed to the level of the gum typically require extraction. However, teeth destroyed only to the level of gum attachment can be saved if there is no damage inside the root.

4. Tooth Perforations Tooth perforations, when a tooth is punctured by an instrument or drill, often lead to the need for extraction. This can cause inflammatory processes.

5. Oncological Diseases In cases of jaw cancer, teeth may need to be extracted along with the affected part of the jaw. This is a specialized area requiring separate consideration.

Possibilities for Saving a Tooth

Pulpitis is not an indication for tooth extraction. All teeth with pulpitis are subject to treatment.

The causes of diseases such as cysts and granulomas often lie in medical errors. For example:

• Undertreated Canals: Poorly cleaned or filled canals lead to inflammation.
• Medication Errors: Root burns from sodium hypochlorite can cause drug-induced periodontitis.
• Resorcinol-Formalin Teeth: Using this method may cause complications and necessitate extraction.

How to Save a Condemned Tooth

1. Endodontic Treatment: Treating the canals of teeth with cysts or granulomas can be successful with the right approach. It is essential to thoroughly clean the canal and use therapeutic agents. Conservative treatment involves regular visits for monitoring.

2. Tooth Neck Lengthening: In cases where the crown portion is fractured below the gum line, tooth neck lengthening can be achieved through surgical intervention. This creates space for the placement of an orthopedic structure.

3. Repairing Root Fractures: Root fractures can be corrected using a combination of surgical and orthodontic methods. It is important to consider the degree of damage.

4. Closing Perforations: Tooth perforations can be sealed with special cement, but this requires working under a microscope to achieve precise results.

5. Removing Broken Instruments: Using a microscope and special tools helps to remove broken instruments without enlarging the tooth canal.

Conclusion

Saving a tooth is both an art and a science that requires knowledge and skill. Even teeth that seem hopeless can be saved with the right approach and modern equipment. It's crucial to consult qualified specialists and not lose hope for preserving your natural tooth. Implantation may be necessary, but in most cases, saving the tooth is the best solution.