Pain? Dental Emergency?!
Master, College of Conscious Sedation American Dental Society of Anesthesiology
Anesthesia for a pleasant escape
Systemic dentistry for a better life
Michael A. Starkey, DDS MS and The Team
Root canal Treatment?
Here is the process one more time
Is it rational to treat the tooth?
What about an implant and tooth in same appointment?
A. If tooth a tooth is to be removed:
2. Bone graft
3. Implant placement
4. Abutment (post)
5. Provisional Crown
After healing a final crown will be needed
This is the highest risk of implant procedures
B. Use of temporary
if bone is too weak for implant and crown and bone graft.
1. Extract and bone graft if not infected.
2. There are options for replacing the tooth extracted short term:
1. Bond a false tooth to adjacent teeth while the socket heals and later graft and implant.
2. Make a flipper: A false tooth you take out. Looks like a denture with only one tooth.
3. Do nothing. Leave without a tooth.
C. If the tooth is already missing
and there is adequate bone:
1. Place implant
2. Place post
3. Place temporary crown
4. It is possible to take impression for final crown at this time but not always.
C. If tooth present and NOT enough bone and infected area:
1. remove tooth while on antibiotics.
2. Clean out infection. Do NOT graft
3. After healing then an implant and graft can be placed at same time but sometimes only bone graft.
4. If socket infected it is possible that after tooth removed and socket heals there is enough bone without need of implant.
1. Do nothing
2. Extract and do not replace
3. extract and replace later
4. replacement options?
a. bone graft needed?
b. Implant post & crown
c. removable one tooth bridge
d. Fixed bridge with crowns
e. Bonded bridge
Same day extraction, implant, and crown. This took about an hour 15 minutes.
The longest process and statistically most successful is the following implant steps:
1. extract- wait for bone to heal up to six months.
2. Bone graft if required this will need up to six months or more.
3. Place implant and cover with gum tissue. Allow 3 to 6 months to heal.
4. Uncover dental implant and place tissue former to get gum tissue to be more esthetic. Gum grafting may be required. Allow six weeks or more for soft tissue to heal.
5. Place special mandrel and take impression to have lab create custom abutment and precision fit crown.
6. Seat crown.
You can see it can take a year and a half or longer. In some instances bone grafting will have to be done twice.
Bone is the key. And the more bone that is missing the harder it is to graft new bone into a defective area.
This is an example of Dr. Starkey's work. It is an extraction and immediate implant placement along with immediate implant post and a provisional crown.
Single tooth implants
Like all implants success is mostly dependent upon the amount of bone available. The implant and provisional crown can be placed at the time of the extraction in certain instances or if the surgery is in an old healed site. There are risks however. Patients often want to know if a mini implant can be used instead of regular diameter implant. The answer is sometimes they can be but not most times.