I have finally found an oral surgeon who agreed to pull my root-canaled tooth and am trying to schedule this extraction ASAP, maybe as soon as this Friday. My question is whether this doctor should be the same person who does my implant. I see everyone advertising their implant business now, but I had always thought for some reason that only periodontists did them. I'm wondering what to do now, since I haven't even fully decided whether or not to have an implant and I'm wondering about the preparation of socket (he mentioned bone grafting?) during the extraction surgery. What do I need to know? Bryanna, would love your help here!

Sadie,

Oral surgeons have been placing dental implants routinely for many years. Periodontists have been placing them more recently.... maybe 10 yrs or so.

It is important to discuss with the oral surgeon at the time of the extraction the preparation of the socket for a future implant even if you decide not to have an implant. The bone grafting encourages new bone to grow in that space which is beneficial irrelevant of whether you have an implant placed later on or not. You have about a year to place an implant in newly grafted bone. After that time frame the bone will start to recede if there is nothing in it to maintain the level.

The socket needs to be healthy in order for the bone graft to be placed. If the socket is infected... the graft will also become infected and fail. So the oral surgeon would make a judgement call once the tooth is removed as to whether the graft should be done at the time of the extraction.

Regarding the extraction....
It is imperative that:
The tooth be removed as gently as possible...
The periodontal ligament be completely removed...
The socket and bone be thoroughly debrided of all necrotic tissue and bone.

Dental implants are titanium or zirconium and look similar to small screws. The bone needs to be healthy and plentiful in order for dental implants to integrate properly and healthfully.

Bryanna

Thanks again for your help and patience, Bryanna. I guess that explains why he was unable to say whether or not he would be able to do the grafting at the time of the extraction, depending on what he finds in the socket. Does that mean I would then have to return for bone grafting, then wait another 3 months (or more), then have the implant? And would that separate bone grafting procedure mean opening the socket again? Sorry for all the questions but I am really nervous about the extraction itself (and part one of the resolution of the root canal issue) so even though I thought I asked the oral surgeon every possible question, I guess I missed a few!

Sadie,

If the surgeon feels that the surgical site is not healthy enough to receive the graft, then he will suture it closed and wait a few weeks or so to go back in an place the bone graft. He may see you in between that time to evaluate the healing. It all depends on what he finds at the time of the surgery.

The jaw bone heals very slowly. It takes about a full year before the bone is actually filled in completely. So to go back in to do the bone graft within a reasonable amount of time is not a big surgery.... less surgery than the extraction. Yes, he has to reopen the site and pack the graft into the socket.

The third surgery would be to place the dental implants and that surgery should wait until 4-6 months post op the bone graft. Earlier than that and the graft material may still be a bit mushy.

I hope I have answered your questions okay.... let me know!
Bryanna

That was very clear, Bryanna! Thank you!

Just a couple more if you have the chance:

Does everyone need a bone graft to get an implant? Is it ever possible to have enough bone following the extraction to do implant without grafting?

Does this mean I could have the bone graft and wait up to a year to have the implant?

Just wondering how to get through all this as efficiently (and with as little jaw trauma) as possible. And trying to be more informed than I was before my first root canal!

Hi sadie,

Anytime a tooth is extracted there will be some degree of bone loss. The hole where the tooth was will fill in but not completely. Over time the bone will recede further until the ridge is flat. The bone graft that is packed into this hole will stimulate the growth of new bone to integrate with it. So the graft eventually becomes your own bone reducing the overall loss of bone. In most patients, even if an implant is not placed in this bone, the loss of bone will be less than if no bone graft were placed. Some people will naturally have less bone loss than others..... its an individual thing and is not predictable.

Generally if a tooth was removed due to reasons other than infection or if the infection was caught early on .... an immediate implant can be placed without using bone graft material.

It is "ideal" to have the implant placed within 6 months or so after the bone grafting. This is the midway stage of healing and if it is successful then the implant will integrate nicely with the bone as the socket heals completely over the course of the next 6 months.

Bryanna

Thanks as always, Bryanna.

It looks like I might be having both my root-canaled teeth extracted at the same time. I'm pretty scared and upset. I was trying to deal with one at a time (for both physical and financial reasons) but it seems like the second one needs to come out ASAP, so I might as well get it over with in one frightening procedure. I had asked all those questions because I was trying to figure out how I was going to fit in the other extraction along the way, but now I have to figure out what my mouth is going to look like with a big hole where the two teeth were, and how to best protect my jaw (where I already have pretty severe TMJ) during the time I'll be recovering. Also how I am going to pay these bills on top of two destructive but expensive RCTs.

Two(ish) questions:

1. If money were no object: what would your advice be about doing the extractions together? Is it more trauma to my jaw or less? More complication-prone or less? My original instinct was to do one extraction and try to make sure everything went smoothly, then go back for the second. But it seems like that will be more expensive and just prolong the discomfort. I would guess that having working teeth back there would be more helpful for the TMJ, but I am also worried about the impact of all the procedures on my already throbbing jaw.

Whichever way I do the extractions, separately or together, they will both have to be done within the next couple of months or sooner.

2.Since money IS an problem, unfortunately, would it be possible to start with one implant? I understand the window is not open for too long before the bone reverts, but how long would it take to know if one implant "takes" and doesn't cause any additional trouble?

Sorry if this is confusing to read. I am only just processing everything that has to happen in the next few months.

Is it fair to ask my endodontist for a refund on a root canal that failed within 2 months? He also gave me a consultation on my first (failed) root canal before he did the second one, so he was completely aware of my situation (which he acted like NEVER happened to anyone before in the history of root canals). I just feel like I was duped into that root canal; it never should have happened.

sadie,

I re read all of your posts about these two teeth. I would not be surprised if one or both of them were fractured. Of course this is often difficult to diagnose until the teeth are removed because the fracture often does not show up on the xray and it is usually too far down the tooth to be seen clinically.

Aside from the fracture possibility.... the teeth are root canaled which automatically means they are unhealthy. So when you ask me about removing them... the only thing I can honestly say to that is.... ask yourself if you are comfortable with retaining two chronically ill teeth. If you are... then your dentists will re treat these teeth again and again as long as you are willing to do that. I know that sounds horrible .... but it is the way most dentistry is practiced all over the world because most people have no clue what is really going on and they are afraid to have their teeth removed :/
I don't think the decision to remove teeth is an easy one... not at all. And there are consequences to removing teeth that need to be considered prior to taking them out. However, on a personal level when I'm faced with two options and one of them is likely to cause me a systemic (possibly permanent) problem, I will always choose the healthier option. But that is just me.... you need to decide what is best for you. I am here to give you the information that you are not getting from your dentists.... and it's not easy for me to give it to you :/

Two teeth being removed in a row is a bit more complicated than removing one in the fact that the bone is going to more open than compared to removing one tooth at a time. On the flip side of that.... the surgery is one time and the healing takes place together. If you were to remove them at different times... you would have to discuss how long in between you should wait. If both teeth are causing you pain and one is removed, you will still have pain.

It is never ideal to have missing teeth as that can impact your ability to chew properly and cause pain in the TMJ area. If you could plan on replacing them within a reasonable amount of time, then you would minimize those complications. Ask you dentist if you are a candidate for a removable partial denture....at least until you could decide about the implants.

Bryanna

First of all, thank you so much for taking the time to reread all my posts about these teeth. I really can't thank you enough, Bryanna. And I think you are right, that I fractured the tooth (I felt the crown move when I was chewing something, then the pain began) last November and that pain led me to get the root canal in December. Not sure what happened in the case of the second root canal; I was still feeling cold sensitivity from the root-canal next to it? I guess it COULD be fractured; the RCT was pretty hard-core as all of the canals were calcified. Even with anesthesia it felt like a jackhammer. All of this compounded by gum pain, TMJ (which grew worse as time went on), etc...

Just to clarify: I'm not uncertain about pulling the teeth; I've realized they both needed to be extracted for some time. I'm just worried about the making things worse, since I now regret every decision I've made so far. Now I am second-guessing myself with everything. So I have no idea how to do it the most gentle way possible.

It seems logical to pull both of them together from my perspective. I want the pain gone ASAP, and the recovery happening at the same time rather than weeks (or months?) also makes sense. On the other hand, I also realize that two teeth is probably double the trauma for my jaw, which is already in spasm from everything it's been subjected to in the last year. I never used to get headaches, ever; now i have them every day, sometimes for most of the day.

I want to have both of these teeth out this coming week. But I'm scared that if something goes wrong with that, I will be in an even deeper mess than I am now. Double the risk, double the trauma? But on the other hand, what you said about waiting also worries me: if I just pull one, the other one will still be painful all through my recovery from the first extraction, and may interfere with the outcome.

I've waited patiently on the advice of my dentists; now I am fed up with these teeth. Of course, I don't WANT to have either of them out; I wish I could roll back the clock and not have either RCT. They are both painful, and have been since the RCTs. But now it's just a matter of timing the extractions to do the least harm to my jaw (and the rest of me). I know you probably can't advise me this specifically, but if it were your two teeth, would you extract them simultaneously?