Tooth Extraction, Grafting, and Dental Implants

Reproduced with permission from the
American Association of Endodontists

In some cases, deep decay or a crack can damage a tooth so severely that it cannot be saved.  When a tooth is damaged to this extent, it needs to be removed (extracted) from your jaw to prevent future infection.

What are my options if my tooth cannot be saved?

Reproduced with permission from the
American Association of Endodontists

Although no further treatment after tooth extraction is an option, missing teeth affect your ability to chew, speak, and smile.  Missing teeth that are not replaced negatively impact your overall health and can contribute to shifting of other healthy teeth, periodontal disease, and tooth decay.  In most cases, extracted teeth should be replaced.

Missing teeth can be replaced in three ways:

Reproduced with permission from the
American Association of Endodontists

1. A dental implant is an artificial tooth root, usually made of titanium, that is placed into your jaw in the location of your missing tooth to support an artificial tooth. Dental implants have been successfully used for decades to replace missing teeth. They are often the treatment of choice to replace missing teeth.

2. Fixed partial denture (also known as a bridge):  A bridge is an appliance that fills in the space created by your missing tooth with an artificial tooth that is permanently cemented to teeth adjacent to the missing tooth.  Bridges cannot be removed from the mouth.  They are commonly used to replace one or a few missing teeth.  While bridges do replace missing teeth, they cause teeth adjacent to the missing tooth to bear the burden of biting forces that were previously supported by your missing tooth.  Flossing is a bit more challenging with bridges as well since the replacement tooth is connected to the adjacent teeth.

What happens during dental implant placement?

Preparing the Implant Site: Before a dental implant can be placed, the diseased tooth needs to be removed (extracted) from your jaw.  After the tooth has been extracted, the bone that surrounded the tooth root is carefully evaluated.  When intact bony walls are present, new bone will predictably grow into the area previously occupied by your tooth root during the next several months.  If the bone that surrounded your tooth root was damaged by the disease process, the area needs to be grafted to grow new bone in order to place an implant.  Grafting involves filling the space in your jaw that was previously occupied by your tooth root with small particles of bone, covering the area with a collagen membrane, and suturing (stitching) the gum tissues over the membrane.  If the extracted tooth is in a highly visible area, your general dentist can make a temporary tooth replacement for you while your bone is healing.

Evaluating the Implant Site: After several months of healing, the thickness and height of bone in the area is carefully evaluated to ensure there is enough bone to secure the implant without impinging on vital structures such as nerves, major blood vessels, or sinuses.  If enough bone is present, a guide is made to place the implant in the best orientation for your artificial tooth while avoiding vital structures.  If there is inadequate bone in the area to support an implant, additional bone grafting procedures may be needed to enable implant placement.

Placing the dental implant: After numbing the area, a small incision is made in your gum tissues which are then lifted away from the bone.  Using the surgical guide made at your previous appointment, a small hole is made in the jaw and the orientation is checked on an x-ray.  The initial hole is then enlarged and the implant is slowly twisted into place in your jaw.  If the implant is not secure in the bone, your gum tissues will be sutured over the implant to cover it for a few months to allow the bone to lock the implant in place.  If the implant is secure when placed then a healing abutment will be secured inside the implant to guide the healing of your gum tissues.

Restoring the dental implant: Approximately 2 months after the dental implant is placed, your general dentist will take an impression of the implant and surrounding teeth.  A lab will use the impression to make a crown that will fit precisely into the implant.  Typically your dentist can cement the crown onto the implant a few weeks after the impression is made.