If a tooth has to be removed because it is too decayed, or because the gum problem affecting it is too serious, it must be done as atraumatically as possible, to preserve the bone and allow possible rehabilitation solutions to follow.
The idea of removing a tooth is always traumatic, because it is rightly seen as a mutilation and a loss, as well as being considered as an invasive and bloody intervention.
There are several reasons why a tooth may be lost.
A tooth may have a very large and destructive carious lesion, which makes the remaining tooth tissue too small to allow adequate reconstruction. Or the carious lesion may have involved the floor of the tooth, causing a perforation, or it may have destroyed the wall so much under the gum that it can no longer be restored.
A tooth can fracture due to direct accidental trauma, when even if healthy it can break (think of an olive stone, for example!), or due to even minor trauma suffered by a tooth that has already been extensively reconstructed but is not protected by a crown. Even in this case, unfortunately, the only possible solution will be extraction of the fractured tooth.
But a tooth can also be lost for periodontal reasons, which is currently the most frequent cause of tooth loss in the western world. In these cases, the patient finds it hard to understand why the dentist is extracting a tooth that the patient considers to be ‘healthy’, as it is not affected by carious lesions. In these situations, the periodontal disease has completely destroyed the supporting tissue of the tooth (particularly the bone) so that the tooth itself moves, horizontally and/or vertically.
Its mobility causes further damage to the gum, a further increase in the pocket, and so a vicious circle is created that inevitably leads to the need for extraction. Failure to remove a periodontally compromised tooth in time inevitably leads to significant bone damage, which can compromise the adjacent teeth and even make any prosthetic rehabilitation impossible later on.
Furthermore, there may be a need to remove a tooth even if it is healthy. This is the case with wisdom teeth, sometimes even impacted in the bone, which with their presence and bad position can cause pain or damage the tooth in front of them.
But what really makes tooth extraction important and delicate?
The extraction itself, which today with the available techniques should be performed atraumatically, makes this moment as minimally invasive as possible. An atraumatic and minimally invasive avulsion will also less damage the bone, allowing faster healing and less post-operative pain. The placing of special substances in the post-extraction socket (such as biomaterial or collagen) will finally make the healing of the area more predictable, favouring faster bone regrowth, fundamental for the preservation of the crestal profile, which is indispensable in the event that implantology is to be used later on or in the event that a total prosthesis is to be worn in the future.
