Extract and Implant vs. Crown Lengthening

The decision-making process as to when to save a compromised tooth as opposed to extracting it has been influenced by the predictable success of dental implants. Factors considered in saving a tooth include whether there is enough structure left to support a crown; is the decay or tooth fracture so deep as to require a root canal or osseous surgery; is retreatment of a previously done root canal required; does bone need to be removed in order to make a proper-fitting crown; and what is the dental status of the adjacent teeth?

The following case typifies how these and other factors help the patient and treating dentist decide on the best treatment course for a problem tooth.
A 25 yr old female presented with a post-and-core fractured at the bone level on tooth #29 (Fig 1). The crown could no longer be attached, the root canal filling was incomplete, and the adjacent tooth (#28) had no restoration.



figre 1 : The tooth structure is at the bone level.

To save the tooth, bone needed to be removed (crown-lengthening) in order to gain enough root structure to fabricate a properly fitting crown. Weighing the many treatment steps and risks necessary to save this tooth – removing the post to retreat the root canal or performing a root-end surgery known as an apicoectomy, removing bone, and fabricating a restoration that has an unfavorable crown-to-root ratio, it was decided to extract the tooth and insert a dental implant.



Figure 2. Tooth removed.

Figure 2 demonstrates the tooth removed and a direction indicator to help determine the implant placement. The osteotomy site was prepared and a NobelBiocare Active implant inserted into the site (Fig 3).



Figure 3. Implant in place.

In this case, it was determined that the best treatment for a 25 year-old patient was not engage in the multiple risks to save the tooth that would leave the patient the patient with a compromised tooth. This treatment choice resulted in preserving bone, not damaging the adjacent teeth by making a bridge, and being able to insert a dental implant at the time the tooth was extracted in order to provide the most predictable and lasting treatment for a severely compromised tooth.