Periodontal Disease and Tooth Restoration Options - Dentistry

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Questions about periodontal disease, tooth fractures, and bone grafting for dental implants?


Hello, Dr.
Tseng.
Six months ago, I experienced pain in my second molar and swelling of the gums.
The dentist diagnosed me with moderate to severe periodontal disease and suspected nerve necrosis, with the tooth being loose and periodontal pockets deeper than 7 mm.
At that time, I did not receive aggressive treatment.
Recently, the molar fractured (splitting in half at the gum line, with one side being severely loose), and the gums are swollen.
There is no pain when not eating, but there is pain when biting down.
I have done some preliminary research and would like to visit a medical center.
The possibility of extraction and re-implantation seems high, but I hope to retain the tooth without needing an implant.
I would like to ask you: (1) Which subspecialty should I consult? Periodontology, Endodontics, Prosthodontics, Operative Dentistry, or an Implant Center? (2) If it is determined that I need bone grafting for re-implantation, is it generally done immediately after extraction, or should I wait a month for healing before performing the bone graft? (3) If bone grafting is done more than six months after extraction, will there be issues with alveolar bone loss? Thank you for taking the time to respond.

Barry, 40~49 year old female. Ask Date: 2024/06/16

Dr. Zeng Guanghui reply Dentistry


Hello Mr.
Barry:
1.
You may consider consulting a periodontist.

2.
The decision to use bone graft material after tooth extraction depends on the morphology of the alveolar bone and the severity of the defects.
If the alveolar bone remains intact after extraction, immediate bone grafting may not be necessary.
However, if the remaining alveolar bone is compromised, it is advisable to have a periodontist evaluate the need for immediate bone grafting.

3.
It is common to observe alveolar bone resorption six months after tooth extraction.

Dr.
Tseng Guang-Hui, Department of Dentistry, Nantou Hospital

Reply Date: 2024/06/16

More Info


When dealing with periodontal disease and the subsequent options for tooth restoration, it is crucial to understand the implications of your current dental health and the treatment options available. Given your situation, where you have been diagnosed with moderate to severe periodontal disease, and your second molar has fractured, it is essential to approach this matter systematically.

1. Choosing the Right Specialist: Based on your symptoms and the complexity of your dental issues, it would be advisable to consult a Periodontist first. A periodontist specializes in the treatment of periodontal disease and can assess the health of your gums and the supporting structures of your teeth. They will be able to determine the extent of the periodontal disease and whether your tooth can be saved or if extraction is necessary. If the tooth is deemed non-restorable, they can also guide you on the next steps for tooth replacement options, such as dental implants.

2. Bone Grafting Timing: If extraction is necessary, the timing of bone grafting is crucial. Generally, bone grafting can be performed immediately after tooth extraction, a procedure known as immediate bone grafting. This approach helps preserve the alveolar ridge and minimizes bone loss. However, in some cases, your dentist may recommend waiting for a period (usually around 4-6 months) to allow the extraction site to heal before performing the bone graft. This decision often depends on the condition of the surrounding bone and the specific circumstances of your case.

3. Impact of Delayed Bone Grafting: If you wait more than six months to perform bone grafting after tooth extraction, there is a significant risk of alveolar bone resorption. This means that the bone that once supported your tooth may diminish in volume and density, making future implant placement more challenging. In such cases, additional procedures may be required to rebuild the bone, which can complicate and prolong the overall treatment process.


Additional Considerations
- Tooth Preservation: If there is any chance to save the tooth, your periodontist may suggest treatments such as scaling and root planing, periodontal surgery, or even regenerative procedures that can help restore the health of the gums and bone around the tooth. These treatments can sometimes allow for the preservation of the tooth, avoiding the need for extraction and subsequent implant placement.

- Restoration Options: If extraction becomes necessary, dental implants are often the preferred method of tooth replacement due to their durability and functionality. However, other options such as bridges or partial dentures may also be considered based on your specific needs and preferences.

- Follow-Up Care: After any treatment, maintaining good oral hygiene and regular dental check-ups is vital to prevent further periodontal issues. This includes professional cleanings and possibly more frequent visits if you have a history of periodontal disease.

In conclusion, your first step should be to consult a periodontist who can evaluate your situation comprehensively. They will provide you with a tailored treatment plan that considers your desire to preserve your natural teeth while addressing the periodontal disease effectively. Remember, early intervention is key in managing periodontal disease and ensuring the best possible outcomes for your dental health.

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