Tooth-preserving operations are an alternative to tooth extraction. Tooth-preserving surgery in dentistry Tooth-preserving surgeries

Dentistry itself and dental surgery in particular, like many other sciences, went through several stages and milestones of its development until it reached the modern level. This is due to both the level of technological progress and the knowledge that doctors have accumulated over many decades.

Ancient finds of skull skeletons with preserved jaws indicate that in ancient times the only way to treat teeth was to remove them. Until about the end of the 19th century, this practice was also used quite often, despite the fact that in the Middle Ages there were facts of surgical treatment of teeth, including their transplantation.

In Russia, only after the First World War, maxillofacial and dental surgery was put on a “scientific track.” From this period, throughout the country, and then in all republics of the Soviet Union, faculties and departments dedicated to this area of ​​treatment began to be opened in medical institutes.

Today, a good doctor is considered to be one who, even at the slightest opportunity, tries to save a tooth, rather than taking the path of least resistance and removing it. Of course, your own teeth are always better than implants, which will have to be placed in any case. However, even the best specialist cannot always save a tooth if there are contraindications for this.

There are also patients who themselves will convince the doctor that they want to save the tooth and not remove it, but treat it with conservative methods, and that this is the only correct way out. They will go to doctors until they find one who agrees with them. However, before making a decision “to be or not to be,” you need to consider all the pros and cons, and also find out what tooth-preserving surgery is, what indications and contraindications it has.

Dental conserving surgery is a surgical procedure associated with endodontics and periodontics. They are used in cases where therapeutic treatment is not enough to solve the problem. At first glance, such operations are quite simple, but their complexity lies in the fact that this is, in a sense, jewelry work - all the nerve endings that are located in the jaw area and in the oral cavity are located very close to each other, they do not need to be hurt.

Therefore, a dental surgeon must not only thoroughly know the anatomy of the maxillofacial part, but also have extensive practical experience in such operations - only in this way can one learn to do them well. In addition, you need to have a very good understanding of the reasons that led to the situation, the solution of which requires an operation of this nature.

Therefore, very often, before prescribing it, a consultation is held with the participation of several specialists in different fields of dentistry to weigh the pros and cons. If, for some reason, the operation may harm the person or will not produce results, it is better to remove the diseased tooth.

There are three types of tooth-preserving operations: resection of the root apex, hemisection and corono-radicular separation. All other types of operations are simply their varieties or modifications.

Resection of the apex of the tooth root consists of treating changes in this area. Among all operations, this is the most common. But if it is possible to do without it, it is better not to do it. It is not recommended to perform surgery if the tooth does not bear a large functional load, it is mobile or is so injured that it cannot be restored. Also, the operation is not performed for diabetes mellitus and stage 2 periodontal disease.

Hemisection is performed only on multi-rooted teeth. This is done so that at least one root remains in the tooth, which will take the load when chewing. But in practice, one root is often not enough for this.

Corona-radicular separation, although it exists as a method, is not used in practice, since it involves not only removing the root, but cutting down part of the crown. After such an operation, almost nothing remains of the tooth, that is, it can no longer function fully. Actually, this is the answer to the question of whether this operation is worth doing.

But before you think about surgery, you need to consider a few nuances. Firstly, such operations have many contraindications - much more than indications. Secondly, no dentist will give an absolute guarantee of a good result of the operation if the doctor followed the patient’s lead and did not remove the diseased tooth. Perhaps the operation will be successful and give the desired result, but in this case, the doctor declines responsibility. Thirdly, the cause of the inflammation is first clarified (perhaps it will be enough to eliminate the cause, and the healing process will not require surgical intervention), and consultations are held with other specialists - perhaps there is no point in performing an operation. Fourth, the operation must be very carefully planned.

Despite all the complexity and many conventions for such operations, doctors at our clinic perform them. Therefore, if you have a need for tooth-preserving surgery, you can safely contact our specialists. Before starting treatment, they will conduct a detailed examination and consultation, approaching the issue from different angles. And if such an operation really makes sense, it will be carried out at the highest professional level.

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The main types of surgical intervention include the following procedures:

• – a dental surgeon removes the root tip with a cystectomy. It is recommended to perform tooth-preserving surgery in cases where it is necessary to jointly treat it with a nearby cyst. A hole is drilled through a specially made incision to partially excise the root. To ensure the stability and stability of the tooth, an osteoplastic agent is placed into the cavity, and then the wound is sutured.
• – partial extraction of a tooth with one of the affected roots of a multi-root system. In this situation, the tooth is sawed off from the root, after which the doctor cleans the hole and carefully treats it with an antiseptic drug. An analogue of bone tissue is also placed into the resulting cavity, then it is produced.

In addition to these situations, the following tooth-preserving operations are used in dental practice.

Lengthening the crown of a short tooth

Intervention is recommended for a “gummy smile,” when the tooth visually looks small against the background of the gum. The procedure is often necessary for subsequent prosthetics. The surgeon makes an incision in the gum, forming its ideal contour. To fix the result, sutures are used.

Flap tooth-saving operations

They are produced as one of the popular methods of treating periodontal diseases. The focus of the infectious accumulation of bacteria and pathologically altered tissues, the integrity of which cannot be restored, is excised. The doctor makes an incision in the gum, resulting in a kind of flap of dissected tissue. Afterwards, the deposits are professionally cleared and replaced with osteoplastic material. The wound formed during the tooth-preserving operation is sutured.

When performing operations at the Meliora Dent clinic, anesthetics are used, allowing the patient not to feel pain while the surgeon is working. These include application, infiltration, and conduction anesthesia. The use of technology and the choice of drug always remains at the discretion of the doctor, since he is responsible for what is being done. Do not be afraid of a visit to the clinic - timely care of the health of your teeth and oral cavity can prevent possible complications and prevent serious damage to your health.

Tooth-preserving surgery – pros and cons

Before tooth-preserving surgery is performed, you should obtain recommendations from a therapist and prosthetist. The first determines how long the preserved tooth can last in the oral cavity. The latter gives advice taking into account the subsequent suitability of the tooth for installation of a prosthesis. Many patients consult with several attending physicians at once. Since tooth-preserving surgery requires the expenditure of money, nerves and effort, you should be confident in its effectiveness and usefulness. If the prognosis is questionable, it is often better to limit yourself to simply removing an element of the dentition.

There are indications and contraindications for tooth-preserving operations. Indications include: tumor, granulomas and cysts, gumboil and some periodontal diseases, severe inflammatory processes in the tissues surrounding the tooth and chronic stages of bone tissue destruction. When studying the indications and contraindications for tooth-preserving operations in detail, you should carefully consider the contraindications. These include the advanced age of the patient, the complexly intertwined root system of the teeth, degradation of the root zone of the bone base, diseases of the hematopoietic system, diabetes mellitus, and cardiovascular disorders.

In dental practice, there are a great variety of various diseases of the tooth and gums, and most of these diseases have one outcome - tooth extraction. As soon as the tooth is removed, the question arises about its further prosthetics, i.e. restoration of the lost unit. This can be done either with a dental implant or a bridge, but all these manipulations are quite expensive, so patients often refuse prosthetics.

But often the situation in the oral cavity helps to avoid unplanned removal. Instead of extraction, you can undergo tooth-conserving surgery, which is designed to preserve the tooth with minimal effort.

Types of operations

Such operations belong to surgical dentistry and are performed by a dental surgeon. They are relevant if conservative treatment, i.e. endodontics are impossible for some reason, and the patient refuses tooth extraction.

Plus, after removal, the bone tissue atrophies, i.e. dissolves, and its level decreases both in height and thickness. This is unprofitable from the point of view of future prosthetics, especially if there is talk about implantation.

Tooth-preserving operations are also relevant in the case when the tooth is already covered with a crown or is one of the supports in a bridge. This will allow you to do without tooth extraction and without removing the prosthesis.

Main types of operations:

Root tip resection

You can often find a disease such as periodontitis, characterized by the formation of inflammatory foci in the bone tissue on the roots of the teeth. When they are too large, it is recommended to remove the tooth. In other cases, endodontic treatment is possible, which will save the tooth. If one or another treatment is impossible, resection of the root apexes is performed, during which part of the root is removed along with the source of inflammation.

Hemisection

During this manipulation, a small part of the tooth is removed along with the root, and the resulting space in the bone is filled with bone material. This also avoids tooth extraction.

Dental crown lengthening

This type of operation is often used before prosthetics, helping to lengthen the crown of the tooth by cutting the gums, which somewhat exposes the root. Most often, this method is used for generalized pathological abrasion of teeth, when there is simply nothing to put a crown on.

Operations for periodontal diseases

This includes flap surgery, open and closed curettage, gingivoplasty, etc. All these manipulations are most often aimed at treating severe or moderate periodontitis. During patch surgery or curettage, deep subgingival stones are scraped out, pathologically altered gums are removed, periodontal pockets are sutured, and all actions are accompanied by treatment with antiseptic and medicinal preparations. If the bone tissue is severely damaged, the doctor can lay bone material, which will somehow restore the bone level, reducing tooth mobility.

Root resection

Some teeth, especially chewing ones, have not one root, but three. If one of them is affected by caries or simply rotted, then root resection will help, during which the affected root is removed, and the rest remain intact, and the tooth is in its place.

Retrograde root filling

And tooth-preserving operations often lead to complications in the form of the spread of infection, which they tried with all their might to get rid of. Plus, after resection of any part or even the entire root, the tooth weakens, which can lead to cracks and fractures of the root, especially when it comes to its replacement with a crown or bridge.

One way or another, tooth-saving surgery can be effective when other treatment methods cannot be applied and tooth extraction is unacceptable. In this case, the tooth can be saved for quite a long time and replaced with prosthetics. But it should be remembered that such a tooth is weak and can cause complications at any time.

If previously diseased teeth were removed, modern dentistry uses every opportunity to preserve them. For this purpose, operations are performed, the most popular of which is resection of the apex of the tooth root.

Tooth-preserving operations are a progressive trend in dentistry, the basis of which is the removal of the affected area of ​​the root and filling the defect. Tooth extraction creates problems in the future, but this modern method allows you to save your teeth.

Types of tooth-preserving operations

This method can even be used on teeth that are the supporting point of a bridge or are covered with crowns. If it were necessary to carry out a complete removal, then it would be necessary to restore the dentition again, but in this case its integrity is not compromised.

The following are distinguished: types of surgical treatment:

• tooth root amputation;
• resection of the apex;
• hemisection;
• retrograde filling;
• lengthening of the coronal part.

The choice of treatment method depends on the location and size of the lesion. These methods allow not only to save a tooth in a situation where this would seem impossible, but also to protect bone tissue from destruction. On the one hand, it is easier to carry out extraction, but in the future the patient will face such a problem as prosthetics. There is no prosthesis that is better than your own teeth, so there is no need to rush to remove them.

Formation of a mucosal flap	Cutting off one of the roots	Sawing the tooth crown to the bification level	Curettage of pathologically changed tissues
Removing one of the roots	Removal of pathologically changed tissues	Removing part of a tooth with one of the roots	Filling the hole with a valve

Root resection

This intervention is relevant for molars that have several roots. If one of them is affected, it can be removed, and the remaining ones will hold the crown in place. If the root is perforated or destroyed, then treatment is impossible. In this situation, the only correct solution is its amputation.

Apicoectomy

This technique is similar to the previous one. The only difference is that not the entire root is removed, but only the affected part. Resection of the root apex is possible if the lesion is small and the rest of the root is intact. The cavity that is formed is filled with a special osteoplastic material, which allows the bone tissue to be preserved.

Corono-radicular separations

This type of surgery is also called hemisection. With this type of intervention, part of the tooth is also removed from the root. The defect is filled with osteoplastic material, and the removed fragment is replaced with prosthetics.

Retrograde filling

It is not always possible to fill the root in the usual way. An alternative way is to do this through a perforation in the alveolar process of the jaw. Thanks to this method, it is possible to save teeth that were previously subject to extraction in 100% of cases.

Crown lengthening

This type of intervention is relevant for teeth that have a short crown. This is usually the result of its wear due to an abnormal bite. To lengthen the crown, roots located below the level of the gums are used.

Indications and contraindications for tooth-preserving operations

These techniques are used if traditional treatment is not possible. Typically, such situations arise due to obstruction of the root canal by granuloma, the presence of a foreign object in it, for example, the remains of an instrument. If the channel has a strong bend, then the classical technique cannot always be used.

If the root is perforated, it is necessary to carry out treatment as quickly as possible, since inflammation can spread to the bone tissue. Previously, such teeth were removed, but today there are more gentle options. Tooth resection - what is it? This is a modern technique, thanks to which there is no need for prosthetics. And if in the future it is necessary to carry out the removal procedure, the bone tissue will be in satisfactory condition, which will allow the installation of an implant.

Dental-preserving operations are contraindicated for patients with severe cardiovascular diseases, as well as chronic pathology in the stage of decompensation.

If you cannot decide to remove a tooth, then contact a clinic that will help not to violate the integrity of the dentition. , which performs tooth-preserving operations, are available to everyone, and you will be satisfied with the result.