Tooth Assessment: Extract or Try to Save

 

Patients come in with dental emergencies rather frequently. Sometimes the fix can be as easy as recementing a crown.   Many cases are clear cut.   For instance, when there is not enough tooth structure to build a filling or crown that will last at all, it must be extracted. Another case is when there is radiographic evidence of destruction to the root surface from possibly a fracture or other entities affecting the root.

 

But there are cases where a decision must be made on whether the tooth can be saved, how long will it last, or is there just a better way to hand the situation without the tooth.

An example of this is a 60 year old male patient who had a lot of decay on his upper left canine. This tooth is in that in-between zone where the pluses and minuses must be evaluated. For this patient, I think he could possibly have a root canal with the decay cleaned out leaving a marginal amount of tooth structure to support the final post, core and crown. (By the way, a post and core are materials that go into part of the root canal space to provide stability and some secure structure to help a crown to stay in place). Also, I like to keep canines because they have nice long roots and provide stable teeth for a good occlusion.

On the other side of the coin, this patient had poor home care and a fair amount of decay on this tooth. There is always concern that the patient may revert to his poor home care efforts and this work will fail. He is also scheduled for a deep cleaning, but the bone loss is minimal and the periodontal condition is favorable to keep the tooth. However he would be putting strong chewing forces on this tooth and I’m concerned that the remaining tooth structure will be inadequate to have the proposed treatment last for 5 years. With all of this in mind, I recommended to him an extraction followed by implant placement. This is a much better long term dental solution.