Preservation of the tooth socket after extraction (1098) - Surgery

According to antiplagiat.ru, the uniqueness of the text as of October 16, 2018 is 90.3%.

Key words, tags: tooth extraction, wisdom tooth, bone tissue, implant installation, augmentation, implantation.

Despite the rapid development of modern dentistry, tooth extraction is still a very common operation. When a doctor removes a tooth, be it a dystopic wisdom tooth or a severely rotted molar, in its place there remains a hole, a cavity, which is called the alveolar socket. Previously, the affected tooth was simply removed, and the resulting cavity, the socket, healed on its own, with a significant decrease in bone tissue. But today, when talking about qualified dental care, we should talk about preserving the alveoli in its original state, even in the absence of a tooth.

Anatomy of the alveolar process

The alveolar, or dental, process (from Latin - processus alveolaris) is the part of the upper and lower jaws that extends from their bodies and contains teeth. The development and normal functioning of this structure is ensured by the roots of the teeth located in it. The alveolar process appears only after teeth erupt and almost completely disappears with their loss. After a tooth is removed, the corresponding area undergoes resorption (resorption). Dental alveoli, or sockets, are individual cells of the alveolar process in which teeth are located. They are separated from each other by bony interdental (interalveolar) partitions. Inside the alveoli of multi-rooted teeth there are also internal (intra-alveolar) interradicular septa, which extend from the bottom of the alveoli and divide the alveoli into chambers (according to the number of roots). The alveolar socket of the tooth has clear, defined boundaries, and it has all the conditions for bone regeneration; you just need to help it maintain its contour.

Our doctors

Clinic director, implant surgeon, orthopedist

Berezin Pavel Nikolaevich

Chief physician, therapist, periodontist

Sakhnova Galina Leonidovna

all Doctors

Hole preservation procedure

Preservation of the socket of an extracted tooth is a fairly simple and effective operation for preserving bone volume and maximizing the preservation of the natural contours of the alveolar socket. This surgical procedure is performed under local anesthesia and does not pose any risk.

Usually the operation is carried out in several stages:

treatment of the hole after tooth extraction with special antiseptic compounds;
installation of a membrane to protect the vestibular wall;
filling the socket cavity with granular bone-forming substance;
fixation of the operating surface by tensioning the free edges of the connective tissue;
applying a bandage or a thin, neat suture.

Complete healing of the postoperative area occurs by the fourth week, and after 3–4 months, in some cases 6 months, if the condition is satisfactory, this area can be used to install an implant.

How is the procedure carried out?

Tooth extraction at the Doctor Bon clinic is carried out as carefully and carefully as possible. Our specialists will do everything to ensure that this procedure becomes:

— Painless

. The dentist will carefully administer an anesthetic to the patient.

— Fast

. Our doctors use special surgical or classical instruments, taking into account the specifics of the upcoming procedure.

— Has no negative consequences

. The doctor will provide detailed information about the necessary procedures to speed up the healing and recovery process

Following important rules of oral hygiene after a dental procedure will help you avoid unpleasant painful sensations by speeding up the healing of your gums.

Treatment quality criteria

The main criterion for the quality of an alveolar socket preservation operation is its independent complete healing and maximum preservation of bone tissue, preservation of the natural contour and volume of the alveolar ridge, improvement of the condition of soft tissues and simplification of further stages of treatment. If the operation is successful, there will be enough bone tissue in the socket to install a dental implant. Separately, it is worth highlighting the advantages of condomization for the doctor and the patient - this is improved long-term treatment results, more predictable aesthetics and, of course, saving time for the doctor and the patient.

Where does it all begin?

And it all starts with a low-traumatic tooth extraction.

And this is the real problem. Neither patients nor some doctors consider this an important procedure, although proper tooth extraction could save a lot of effort and money during further implantation.

Let's reformulate the problem of the delete operation. Let us designate it not as “ tooth removal at any cost ,” but as “ tooth removal with maximum preservation of surrounding tissue .” Even in case of acute pain. Because if a tooth is literally ripped out with half of the alveolar ridge, no subsequent preservation will help avoid osteoplasty.

Therefore, sometimes low-traumatic tooth extraction takes a long time and requires more than just working with forceps:

then

In general, friends, by spending a little more time and effort on tooth extraction, you can seriously make your future implant treatment easier.

Indications for condom

Preservation of the socket of an extracted tooth is indicated for everyone who in the future wants to install a dental implant in its place. The process of loss and resorption of the jaw bone at the site of the extracted tooth begins immediately after the operation. In the first year, bone tissue resorption will be 25% in volume, and over the next 3 years the loss in width will be 40 - 60%. In the case of socket preservation after tooth extraction, a larger volume of bone tissue in the jaw and the most natural contours of the alveolar process are preserved. And then, subsequently, the likelihood of such a complex operation as alveolar bone augmentation when installing an implant will most likely not be required.

In what cases is tooth extraction necessary?

Our specialists always strive to preserve the teeth of their patients. Removal is carried out only in the following cases:

Tooth fracture
.
Read also: Fang - the seal of evil: signs and superstitions associated with teeth, some of which it’s time to stop believing
Difficulties with wisdom teeth
. Removal is necessary if wisdom teeth shift and deform the dentition, damage the soft tissues of the cheeks during chewing and interfere with a full life in general.
Deformation of the dentition
. If there is an incorrect bite and if there is deformation of the dentition, the removal of interfering teeth is recommended on the recommendation of an orthodontist.
The occurrence of dental diseases
. These include purulent periostitis, sinusitis of the maxillary sinuses, etc.
If it is not possible to carry out prosthetics and install a crown
.

In some situations, resorting to such a radical treatment method is not recommended. This procedure should not be carried out in case of exacerbation of mental illnesses and chronic heart diseases. Contraindications are also certain periods of pregnancy and infectious diseases in the acute phase. In these cases, visiting the dental office should be postponed.

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Contraindications

Preservation surgery is subject to the same restrictions as any osteoplastic surgery. Separately, I would like to note that it is not recommended to preserve a hole after tooth extraction in a state of acute pain, since the risk of complications increases. But in each specific clinical case, the actions of a professional dentist are strictly individual. Sometimes situations arise when you have to take risks, but this is due solely to medical indications. In any case, it is necessary to understand that performing a tooth extraction operation and subsequent preservation on a planned basis is better than as part of emergency care.

this is the paradox...

... that there are very few clear manuals, recommendations and described experience in the conservation of holes. The authors are content with either drawings or not entirely convincing “before” and “after” photographs, from which it is not clear whether the tooth socket healed “on its own” or such healing is a consequence of the conservation procedure.

In other words, in theory everyone knows how and why this is done. I am sure that most doctors are fine with their practice, but very few colleagues are able to clearly demonstrate their own experience. Therefore, in fact, I had to master everything on my own, simultaneously making mistakes and complicating my own work. But who said that implantology and surgery are easy?

Restrictions

It is logical to perform a preservation operation after the removal of permanent molars, within the so-called sevens, second molars (except for wisdom teeth, eights), since when baby teeth fall out, bone tissue does not resorption. There is no upper age limit for performing an operation aimed at preserving the natural contours of the alveolar process.

Advantages of preserving the socket of an extracted tooth

excellent preservation of bone tissue integrity;
no need for complex and expensive procedures for artificial bone augmentation;
protecting the socket from infection throughout the healing period;
an ideal method for working with bone areas on the upper jaw located adjacent to the maxillary sinuses (the risk of injury to the air cavities during certain types of bone augmentation is eliminated).

Price

According to the classifier of surgical interventions in the oral cavity, condomation is not among the standard surgical interventions and this, of course, affects the cost of its implementation. In addition, the price of osteoplastic materials and related products is quite high. Some materials are used only in conjunction with a special membrane to avoid ingrowth of soft tissue into the alveolar socket. The price is also affected by the method of tooth extraction. Removal of a tooth or tooth root is sometimes still a traumatic procedure, leading to direct loss of alveolar bone and soft tissue. With atraumatic removal, the alveolar bone is preserved in a larger volume, which reduces the final cost of the operation.

Preservation of the socket after tooth extraction is an important procedure when planning the installation of an implant. Timely preservation of the socket will allow you to preserve such valuable bone tissue and avoid a much more complex and expensive operation to build it up - augmentation, as well as significantly reduce the overall treatment time. The cost of preserving the natural contours of the alveolar socket pays off, because you thereby provide the teeth surrounding it with a reliable position, and as a result, during implantation, you get an imitation of the removed tooth root. This procedure applies even to those patients who do not intend to restore or replace a lost tooth with an implant, because in this case the gingival contour will have the most aesthetic appearance, without failures, and will allow for the most aesthetic bridge prosthetics. Therefore, reservation is gaining increasing popularity in dental dentistry.

According to antiplagiat.ru, the uniqueness of the text as of October 16, 2018 is 90.3%.

Key words, tags: tooth extraction, wisdom tooth, bone tissue, implant installation, augmentation, implantation.

*Images: Astra Tech Dentsply Implants; Principles of hard tessue regeneration and implant therapy.

Policy regarding the processing of personal data

Purpose of processing personal data:

Medical preventive purposes, establishing a medical diagnosis, providing medical services;
Realization by citizens of the Russian Federation of the rights assigned to them by the Constitution of the Russian Federation to apply to medical organizations in the prescribed manner;
Ensuring laws and other forms of regulations in relation to employees of the Center, assisting employees in training and career advancement, ensuring personal safety of employees, observing basic state guarantees for remuneration of employees, controlling the quantity and quality of work performed.

Categories of subjects whose personal data is processed in the institution:

Persons who contact the Company for the provision of medical services.
Categories of processed personal data of this category of subjects:
- Full Name,
floor,
address,
telephone,
E-mail address,
place of work,
passport details,
TIN,
x-rays,
photos,
necessary for planning and implementation of treatment (prosthetics).
Employees of the Company (within the framework of labor relations).
Categories of processed personal data of this category of subjects:
- taxpayer identification number (TIN);
foreign languages;
work experience;
family composition;
passport details;
address;
information on military registration;
employment contract;
appointments;
professional certification;
training;
professional retraining;
state and departmental awards, honorary titles;
information about holidays;
business trips;
sick leave;
labor activity before being hired at the clinic;
date and reason for retirement;
available certificates;
having a criminal record;
presence of a foreign passport;
trips abroad;
wage;
bank account number;
photos.
The Company's counterparties (within the framework of concluded agreements).
Categories of processed personal data of this category of subjects:
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residence address;
email address;
contact number;
Bank details.

Legal basis for the processing of personal data: Federal Law of July 27, 2006 No. 152FZ "On Personal Data"; Federal Law of July 24, 1998 No. 125FZ "On Compulsory Social Insurance against Industrial Accidents and Occupational Diseases"; Federal Law dated November 21, 2011 N 323FZ “On the fundamentals of protecting the health of citizens in the Russian Federation”; consent of employees to the processing of personal data; concluded agreements with contractors.

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Collection, recording, systematization, accumulation, storage, clarification (updating, changing), extraction, use, transfer (provision, access) within the framework of a tripartite agreement, at the request of the court, on the basis of regulatory documents, depersonalization, blocking, deletion, destruction.

The processing of the above personal data is carried out with and without the use of automation tools.

Information on ensuring the security of personal data in accordance with the requirements for the protection of personal data established by the Government of the Russian Federation:

Legal and organizational measures for the security of personal data: the Company has developed organizational and administrative documents regulating the process of receiving, processing, storing, transferring and protecting personal data.
Technical measures to ensure the security of personal data during processing carried out using automation tools:
use of means of protecting personal data from unauthorized access (systems for differentiating access rights to information, cryptographic protection, use of information archiving programs using the encryption method and encoding of transmitted data on a PC processing personal data; web interface with installed certificates and user authentication);
preventing the introduction of malicious programs (virus programs) and software bookmarks into information systems (Microsoft Security anti-virus package).

When processing is carried out without the use of automation tools:

separation of personal data from other information by recording them on separate tangible media;
determining the procedure for storing physical media of personal data and establishing a list of persons processing personal data or having access to it;
restricting user access to premises where storage media are stored;
placement of storage media containing personal data within the controlled area;
ensuring separate storage of tangible media of personal data, the processing of which is carried out for various purposes;
compliance with conditions that ensure the safety of personal data and exclude unauthorized access to them: storage of documents containing personal data in specially equipped rooms, safes, metal cabinets, installation of bars on windows, fire alarm systems;
conducting an internal audit of the security of the institution’s personal data information systems;
Conducting introductory and ongoing briefings for employees of the institution authorized to process personal data.

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The subject of personal data has the right to receive the following information:
legal grounds and purposes of processing personal data;
the purposes and methods of processing personal data used by the operator;
name and location of the operator, information about persons (except for the operator’s employees) who have access to personal data or to whom personal data may be disclosed on the basis of an agreement with the operator or on the basis of federal law;
processed personal data related to the relevant subject of personal data, the source of their receipt, unless a different procedure for the presentation of such data is provided for by federal law;
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the procedure for the exercise by the subject of personal data of the rights provided for by this Federal Law;
name or surname, first name, patronymic and address of the person processing personal data on behalf of the operator, if the processing has been or will be assigned to such a person;
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The subject of personal data has the right to demand from the operator clarification of his personal data, blocking or destruction of it if the personal data is incomplete, outdated, inaccurate, illegally obtained or is not necessary for the stated purpose of processing, as well as take measures provided by law to protect his rights .

The information specified in paragraph 1 must be provided to the subject of personal data by the operator in an accessible form, and it should not contain personal data relating to other subjects of personal data, unless there are legal grounds for the disclosure of such personal data.
The information specified in paragraph 1 is provided to the subject of personal data or his representative by the operator upon application or upon receipt of a request from the subject of personal data or his representative.
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If the information, as well as the processed personal data, was provided for familiarization to the subject of personal data at his request, the subject of personal data has the right to contact the operator again or send him a repeated request in order to obtain information and familiarize himself with such personal data no earlier than thirty years later. days after the initial application or sending of the initial request, unless a shorter period is established by federal law, a regulatory legal act adopted in accordance with it, or an agreement to which the subject of personal data is a party or beneficiary or guarantor.
The subject of personal data has the right to contact the operator again or send him a repeated request in order to obtain the information specified in clause 1, as well as in order to familiarize himself with the processed personal data before the expiration of 30 days, if such information and (or) the processed personal data were not provided to him for review in full based on the results of consideration of the initial appeal. A repeated request must contain a justification for sending a repeated request.
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The right of a personal data subject to access his personal data may be limited in accordance with federal laws, including if:
the processing of personal data is carried out by authorities that detained the subject of personal data on suspicion of committing a crime, or brought charges against the subject of personal data in a criminal case, or applied a preventive measure to the subject of personal data before filing charges, with the exception of cases provided for by the criminal procedure legislation of the Russian Federation, if permitted familiarizing the suspect or accused with such personal data;
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Responsible for organizing the processing of personal data at Dental Implantation Center LLC is Andrey Aleksandrovich Morzhuev.

Proper oral care after removal.

It is important to follow your dentist's advice regarding oral care after the extraction procedure. Your doctor will explain to you in detail how to prevent pain, discomfort and inflammation. After recovery, you can contact us for implantation and prosthetics. Our qualified dentists will help restore the beauty and naturalness of your smile using the most modern prosthetic methods.

Tooth extraction RUB 3,500.

Tooth extraction (complicated) RUB 5,000.

Tooth extraction with bone grafting RUB 15,000.

Removal of an impacted tooth RUB 15,000.

Curettage of tooth socket RUB 1,000.

Resection of the root apex 10,000 rub.

Increasing the anatomical length of a tooth RUB 10,000.

Excision of the hood (pericoronitis) RUB 3,000.

Lip frenuloplasty RUB 3,000.

Tongue frenuloplasty RUB 2,500.

Gum correction with laser RUB 2,500.

Laser gum retraction (1 tooth) 500 rub.

Treatment of alveolitis (curettage, drug treatment) RUB 1,500.

Open curettage (1 tooth) 1500 rub.

Opening an abscess 2000 rub.

Types of material and types of stitches

In dental practice, the removal of a permanent tooth is a fairly serious procedure, which in some cases is equal in complexity to surgical operations. The only difference is that it is performed in a dental chair.

Often the teeth have a fairly wide crown and a deep root part. To remove such an organ, the doctor has to make additional incisions in the gum, which must be sutured at the end of the procedure. The material for these purposes must be of high quality.

The main objectives of the performed operation are to achieve rapid healing of the empty area in the jaw arch, provide a good aesthetic effect, and prevent the occurrence of undesirable consequences.

During operations, suture material is a foreign body that remains in living tissue until complete healing. Therefore, it is important that the thread is of high quality and has an optimal chemical composition and structure.

Absorbable and non-absorbable sutures are used in dentistry. Below we will consider both types in more detail.

Absorbable sutures

Surgical sutures that dissolve are characterized by sterility, strength along the entire length, resistance to infections and ease of handling. They are divided into natural and synthetic. During tissue regeneration, no procedure is required to remove the tissue.

Depending on the type of raw material, the threads may decompose without leaving any residual components. These include:

Dexon. Braided suture thread made of synthetic material.
The raw material used is glycolic acid hypopolymer. It does not contain collagen. Dexon is contraindicated in clinical cases where constant tension of the tissues being connected is expected. The resorption process starts hydrolysis. On the 20th day, the thread retains its strength by 35%. Complete resorption occurs approximately 2 months after application.
Catgut. Material made from natural collagen thread. The resorption process is triggered by the action of proteolytic enzymes.
Strength lasts up to 20 days. It is eliminated from the body by an enzymatic effect within 55-65 days. The thread is characterized by elasticity, smooth surface, good handling properties, high breaking load, and knot reliability.
Among the disadvantages, dentists point out the ability to cause mild aseptic inflammation of surrounding tissues.
Vicryl. Polyfilament absorbable sterile suture material. It features reliable knot fixation and good handling properties.
May cause minimal initial inflammatory response in tissue. Tensile strength is lost 20 days after application. Complete dissolution occurs after 3 months.
Compared to Catgut, Vicryl is much easier to work with, despite its synthetic origin. It does not have a slipping effect, is more durable and has a predictable time frame for complete resorption. The suture thread decomposes gradually, transforming into acids.

Intestinal sutures (absorbable stitches) have the advantage that they do not need to be removed. They disappear on their own, without damaging the wound and surrounding soft tissues.

Non-absorbable sutures

Modern non-absorbable suture materials used in surgical dentistry today are polymer threads and silk. They have high strength, good handling properties, are distinguished by manufacturability, affordable cost, and are able to remain in tissues for a long time without adverse reactions of the body.

The following surgical threads are widely used by doctors:

Polyester. Non-absorbable suture material of synthetic origin.
It is distinguished by its ductility and resistance to tearing. The basis of the multifilament thread is terephthalate (a thermoplastic polymer) with or without a sheath. Living tissues show minimal reaction to a synthetic base.
Nylon. The material is a synthetic insoluble monofilament.
Made from polyamide by extrusion (pressing a melt of material through a forming device). It has a uniform diameter along its entire length and easily passes through damaged structures without injuring them. Among the advantages, it is worth highlighting the high and constant strength of the node, resistance to infections, and excellent visibility in the surgical field.
Silk. The material is made from a protein of organic origin – fibroin.
The thread can be twisted or braided, coated or uncoated. Dentists often prefer it for its strength, flexibility, ease of manipulation, and ability to securely hold knots. Negative properties are expressed in terms of hygroscopicity and the ability to provoke pronounced inflammatory reactions in surrounding tissues.

When suturing the gum, the dentist selects a suture that is appropriate for a particular clinical case. These can be interrupted or continuous stitches.

The first type is most often used in surgery. Characterized by the presence of stitches independent of each other. Each of them is fixed by a separate unit.

This method of suturing a wound allows you to maintain the integrity of the tissue even if one of the stitches breaks.

Continuous suturing is the tightening of the edges of the wound area with a suture thread, which is fixed at the end of the suture with one knot. For the doctor, manipulation in this way is faster, but leaves the risk of damage to one of the stitches and failure of the entire thread structure.

All the pros and cons of laser removal of a dental cyst, the procedure for carrying out the procedure.

In this publication we will talk about the reality of removing teeth at home for disabled people.

Here https://www.vash-dentist.ru/hirurgiya/udalenie-zubov/molochnyih-u-detey.html we’ll talk about the indications for removing a baby tooth in a child and the cost of the issue.

The mucous membrane of the alveolar ridge - what do you need to know about it?

The mucous membrane covering the alveolar ridge can be divided into two types, attached and mobile:

In earlier literature, the mobile mucosa is called lining, and the attached mucous membrane is called chewing - and this, in my opinion, is a more correct terminology, and therefore in this article we will use it.

The border between the lining mucous membrane and the chewing gum is called the transitional fold. Its position and configuration is an important factor influencing the condition of the gums around teeth and implants, and we will talk about this a little later.

From a clinical point of view, we can distinguish two significant parameters of the chewing gum:

Collectively, they are called a phenotype, but, for greater understanding, hereinafter we will separate them and simply call them:

– D – chewing gum thickness (biotype)

– L – width of the chewing gum area.

Gum phenotype is an individual thing, depends on the genotype or, more simply put, is inherited in the same way as eye color, hair color or leg size. There are people with pronounced and developed chewing gums, and vice versa, there are those who have a little less attached gum area than none:

In 2016, I conducted a large study, part of which I used for my report on the preservation and formation of the gingival contour during the stages of implantological treatment. In general terms, we examined the gingival phenotype (albeit in relation to immediate implantation) in 330 clinical situations:

That is, in almost two-thirds of clinical situations, the width of the chewing gum area L exceeds 3 mm, while biotype D is more than 1 mm in the vast majority of patients:

The study itself and its clinical interpretation are here>>

I'll explain a little later why we need insight into these numbers.
Important note: the phenotype of the mucous membrane, along with the state of the bite, is one of the factors predisposing to periodontitis, an extremely unpleasant disease of the dentofacial apparatus.
From this point of view, it is worth noting that it is not the “susceptibility to periodontitis” and not “periodontitis” itself that is inherited, but only phenotypic risk factors for the development of this disease. Accordingly, knowing the etiology and pathogenesis of recessions, peri-implantitis, periodontitis and the role that the gum phenotype plays in this pathogenesis, a simple question comes to mind:

Can we, by influencing the gum phenotype, reduce the risks of developing recessions, peri-implantitis and periodontitis?

It turns out we can.