Periodontal Extractions and Ridge Augmentation

Periodontal extractions, having a tooth pulled, is a common and very old technique. Sometimes, extraction in adults is a necessary procedure. It is true that teeth are meant to last a lifetime, but often they do not last as long, especially because of poor dental hygiene or massive dental trauma. Periodontists and dentists perform this operation often, but modern technology allows modern periodontists to perform extractions with a level of precision and care impossible in the past. Aesthetics are also just as important of a concern for the modern periodontist, especially for patients like those in Manhattan. A periodontist employing minimally invasive techniques is uniquely qualified to perform even demanding extractions and socket augmentation techniques to reconstruct the deficient ridge.

When a tooth is removed, however, an empty socket is left in the ridge bone. This empty socket will often heal on its own, filling in with bone and tissue, but that is not always the most pleasing look. Sometimes, however, that socket doesn’t heal properly, and the socket will continue to deteriorate. To maintain a perfect smile, there are a number of techniques that periodontists can use. Ridge augmentation is a common dental procedure that often follows a tooth extraction to recreate the natural contour of a gumline and to fix the bone loss that may result from extraction. This procedure can not only restore the altered look after a tooth extraction but can mitigate the possibility of decay after extraction.

Extraction techniques and concurrent socket augmentation, with or without implant placement, can “make or break a case.” The task of creating an esthetic result or maintaining normal ridge anatomy can become either simple and predictable or complex and arduous. Complicated procedures produce a great amount of pain for the patient. A painful extraction can result in an incomplete or delayed treatment plan because of the patient’s anxiety about further discomfort in the chair.

Having the proper surgical and prosthetic diagnosis is critical in achieving ideal results.  Extractions and socket augmentation techniques often require bone and soft tissue augmentation, implant placement and the creation of components to support the transgingival region.

Microsurgery affords the opportunity to provide minimally invasive treatment. With high magnification and illumination, roots can be sectioned within the socket with minimal damage to bone and soft tissues.  Flaps are not reflected, and socket augmentation and/or implant placement can be performed in an intact periodontium. The healing response is more rapid and enhanced.  In addition, with little or no insult to bone and gingiva, post-operative pain is significantly reduced.  Below are photographs of three different cases from Dr. Kissel’s Manhattan office.

fig.1 Complex Tooth Removal: Carious roots that communicate with sinus lining.  Two of the three roots were sectioned multiple times for atraumatic tooth removal. Gutta percha was then dissected off sinus lining.

fig. 2 With high magnification and illumination roots can be sectioned within the socket with minimal insult to bone or gingiva.

fig. 3 Complex Tooth Removal 3 Radiographs: Preserving and then expanding the inter-radicular bone results in immediate implant placement

Patients in Manhattan that need extractions choose Dr. Kissel for his proper consideration of the needs of patients, the professional and comprehensive quality of care, and his familiarity with the cutting edge of periodontics technology.

When a patient needs to choose a periodontist, they should contact the Manhattan office of Dr. Kissel first for a consultation by calling (212) 702-9088.