Most dentists don't take recommendations to extract teeth lightly. When a tooth is extracted, it affects your entire mouth. A gap in your smile can cause the teeth around it to shift, and it can even lead to problems with the tooth that is directly above or below it, as that tooth then doesn't take part in the chewing process any longer. Almost all dentists agree that you should take every step you can to save a natural tooth before extraction is even considered. The first step is typically a root canal, which is the only procedure many people need. If the root canal "fails", then extraction is not your only option. Your dentist may recommend one of the following procedures to help save the tooth.
Even the best dentist often faces a challenge during root canal procedures when a patient has many very tiny canals that need to be cleaned out. If even one of these tiny canals is not fully cleaned out, the tooth can become re-infected. When the infection is located at the apex, or tip of the root, then an apicoectomy is often the best way to save the tooth.
During an apicoectomy procedure, an endodontist makes a very small incision in the gum tissue in front of the bad tooth and surgically removes the tip of the infected root and any other infected jaw tissue. A few stitches are then placed to re-seal the gum tissue. This procedure is very common because it is minimally invasive and can target just the problem area of the tooth, the root tip, without having to re-open the sealed crown of the actual tooth.
A hemisection can also save a tooth that needs more than just a root canal to save it. Hemisections are only performed on lower molars with two roots, although similar procedure called a trisection can be performed on upper molars with three roots. The the end goal of this procedure is to split a tooth into two separate sections that each have their own root. In a way, it is like turning one tooth into two (or three). These procedures are often performed at the same time as root canal procedures, although they can be performed on teeth with failed root canals as well.
Many people don't realize that tooth decay can actually spread to the jaw bone. When this bone is infected, a hemisection allows a dentist to remove the infected tooth material between the two roots and any infected jaw-bone tissue. Once the tooth is split, it is then often best to just keep it in two pieces instead of one. That can help you then clean the once-infected area clean more easily to keep it healthy.
During a hemisection procedure, the endodontist will first make an incision in the gum tissue above the tooth, similar to how it is done before an apicoectomy. The entire tooth is the split and decayed material removed. Then, separate crowns are often placed on both sections of the new tooth, or "teeth".
3. Intentional Replantation
It may sound odd at first, but there are times when it is a good idea for an endodontist to pull out a tooth, and then put it back in. This is called intentional replantation, and it can help after a failed root canal procedure. It is often performed in place of an apicoectomy when an apicoectomy cannot be performed due to where the tooth is in the mouth or another reason.
This is considered a "last resort" procedure when all else has failed or is not an option for saving a tooth. During the procedure, the endodontist extracts the tooth, then removes decay and infected material. Since the tooth is not in the mouth, removal of "bad" areas of the tooth can be done much more thoroughly. The tooth is then reinserted in the mouth, and it is splinted in place until it heals.
Although often very effective, it is considered a "last resort" because there are times when the mouth does not "accept" the tooth back in, and it will then have to be removed permanently after all and replaced with a dental implant, bridge, or another artificial tooth option.
Don't have that tooth extracted unless you have no other choice. The problems you will face in the future with an artificial tooth and with the rest of your mouth can be avoided by opting for one of the above procedures performed by a good endodontist at a place like Maplewood Dental Associates, PA.