Bone Grafting During Extraction
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What is a dry socket?
A dry socket occurs when a clot is not properly formed within the extraction socket and the
bone remains unprotected and exposed to the oral environment. A dry socket can be painful.
The dry socket occurs when the healing process starts at the bottom of the socket and works
its way up instead of closing over the socket. A number of factors can contribute to the
formation of a dry socket. These include the presence of infection, poor blood supply to the
area, lack of formation of a clot and the overall health of the individual.
An individual will know that a dry socket has occurred by the second to fourth day after the
extraction, due to the onset of a foul taste, a bad odor and radiating pain.
Dry sockets can be treated by your dentist, helping to provide great relief. The treatment
involves flushing the socket free of food and tissue debris with warm sterile saline solution,
followed by placing a soothing medication into the socket. A second visit is usually required
to repeat the treatment. In about two weeks the gum tissue will have closed over the socket,
allowing for proper healing. By this time, the pain has usually subsided.
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The main goal of modern dentistry today is the prevention of tooth loss. The loss of a single
tooth or multiple teeth can have a large impact on your dental health and appearance. All
possible measures should be taken to save your teeth. However, in some situations, once the
examination, x-rays and history have been done, the dentist may find it in the best interest of
the patient to extract the tooth.
Teeth require extractions for a number of reasons:
- Abscess or infection
- Heavy decay not allowing for restoration
- Advanced (gum) periodontal disease
- Crooked or overcrowded teeth
- Impacted teeth
- Fractured (broken) teeth or roots
Extractions can be either termed "simple" or "complicated." An extraction is usually considered
simple if there is enough tooth structure above the bone to grasp onto, making its removal
very easy. A simple extraction involves loosening the tooth from its bony socket using forceps
and or elevators, and removing the tooth from the bone. There is minimal trauma to the
surrounding tissues and area. Most patients will experience little or no discomfort with a
simple extraction.
An extraction is usually considered complicated if a tooth is fully or partially covered by bone
and soft tissue, or if a tooth has deteriorated so much by decay or large restorations that very
little tooth structure remains. In these situations, there is not enough tooth structure to grasp
onto, making the extraction procedure more difficult.
A complicated extraction may involve reflecting gum tissues to expose the tooth and
surrounding bone. Bone removal may also be needed to expose the tooth and gain access to
the area. Sometimes a tooth needs to be sectioned (cut into pieces) to allow its complete
removal. In this situation, stitches are generally required. Patients will usually experience
some postoperative discomfort for several days following the extraction, such as tenderness
of muscles, swelling or bruising. Most of this can be controlled with pain medication prescribed
by your dentist and a list of postoperative instructions.
Teeth may also be considered for extraction if they do not function or do not assume their
proper position in the arch. Wisdom teeth are the most common teeth to be extracted and
generally fall under the "complicated" category.
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The extraction of Wisdom teeth can range from simple to difficult and may be quite involved.
Most extractions are routine, however some difficult extractions can lead to such things as
bleeding, infection, swelling and pain.
Upper wisdom teeth are often separated from the sinus by a thin bone and membrane.
Occasionally when wisdom teeth are removed a small hole is formed between the sinus and
the extraction site. If this happens, the area can be closed with a small suture. The patient
is then instructed not to blow their nose, forcefully for several weeks. Decongestants and
antibiotics are prescribed and the patient is seen in several weeks for a follow up to check
progress.
Lower wisdom teeth often have roots that wrap around or lie very near to the inferior alveolar
nerve. This is the nerve that supplies all sensation to the tongue, teeth and lip on each side
of the mouth. Sometimes during extractions this nerve can be bumped or bruised causing a
change of sensation on the side of the face where the extraction occurred. In most cases the
nerve heals on its own over time. It can take from six months to one year for normal feeling
to return. In rare situations, the nerve damage may be permanent.
With the extraction of wisdom teeth one can expect swelling and difficulty in opening because
of stretched muscles. One might also experience an earache, sore throat and increase in
temperature for one or two days. Bruising may occur and last for several days. The corners
of the mouth may be dry and cracked from stretching.
The patient is sent home with postoperative instructions and some pain medication. If stitches
were placed the patient will have to return in about 1 week to have them removed.
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The third molars are the last teeth to form. They usually grow into the mouth during the late
teenage years.
It is very common for wisdom teeth to become impacted within the jawbone. Impacted teeth
are unable to erupt fully into the mouth and become trapped within the bone. There are many
factors that can cause wisdom teeth to become impacted, however, regardless of the cause,
these teeth are usually removed to prevent destruction of the surrounding bone and teeth.
When a lower wisdom tooth is being considered for extraction, the location of the nerve and
blood vessels is first determined. The dental nerve and blood vessels are located in a canal
within the lower jawbone, and in some situations, this canal is very close to the roots of the
wisdom teeth and could be damaged during extraction.
Types of Impactions:
Complete Impaction
A complete impaction occurs when the tooth is trapped within the jaw and is totally covered by
bone. This type of impacted tooth can eventually result in the formation of a cyst. Depending
on the proximity of the tooth to the nerve, a completely impacted tooth should be extracted to
prevent complications later.
Partial Bony Impaction
A partial bony impaction occurs when the tooth starts to erupt but is unable to completely
erupt into the mouth, leaving part of the crown of the tooth through the gum tissue. This type
of impaction can eventually lead to decay of the tooth and destruction of the surrounding bone
by bacteria that can become trapped underneath the gum tissue. In some cases, the adjacent
teeth may also become affected. This type of impaction can become painful if an infection
develops around the tooth and bone.
Regardless of the type of impaction, most impacted wisdom teeth are extracted to prevent
further complications. These types of extractions are best done at an early age, since the
bone is softer, making the extraction easier. Although the extraction of wisdom teeth is a
surgical procedure, associated with some discomfort, removal of these impacted teeth can
help maintain the health of the bone, soft tissue and adjacent teeth.
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