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have been created by Dr. Jeffrey Dorfman, Director of The Center for Special Dentistry
Hopeless Broken tooth, Non-Restorable teeth,
Click on the small photos below to enlarge.
This is an example of less than ideal dentistry. 1) There is a cavity under this crown. 2) There is a cavity under this adjacent crown. The root canal filling (arrows 3, 4 & 10) does not extend to the end of the tooth root (arrows 5, 6 & 11). 7) & 8) X-ray evidence of an active root canal infection in the jaw. Pain in this tooth was the reason for this new patient visit. 9) A poor-fitting prefabricated post. The molar tooth will likely need extraction and replacement with a dental implant and new crown. The premolar tooth will need root canal retreatment, a new post, possible gum surgery and a new crown.
Orthodontic teeth braces complications. 1) & 2) This patient presented with a hopeless upper front tooth #9 under an unattractive dental crown. This tooth was maintained for one year while her teeth were being orthodontically aligned - moved with braces. The #9 tooth root was then extracted from under the crown to allow the gum and bone to heal with about eight months remaining to complete her braces. 3) & 4) This rootless crown #9 is being held in place only by the orthodontic bracket and wire. This patient preferred to keep this unattractive crown during her braces treatment to minimize simultaneous cosmetic changes, but a cosmetic temporary dental crown could also have been used during this time. A dental implant will be placed about three months following the extraction. The second stage implant connection will coincide with the braces removal.
Single tooth dental implant placement in the first premolar site after extracting a hopeless cracked tooth where the surrounding gums were not infected. The lower left second premolar position already has a dental implant as well. 1) - 2). Pre-op photos show the badly chipped tooth, clinically and radiographically. 3) The tooth socket is exposed and ready for dental implantation. 4) Photo of the extracted tooth. 5) A Replace titanium threaded dental implant ready for oral surgery insertion. 6) The implant was inserted into mandible using a slow speed handpiece dental drill. 7) Implant covered and surrounding gum tissue sutured using 3-0 chromic gut dissolvable sutures. 8) Post-op xray.
This patient presented with a tooth crown that had broken off a molar tooth that previously had root canal therapy. Preparation - drilling - into the pulp chamber revealed extensive subgingival decay - tooth cavity below the gums - and furcation involvement. This tooth should be extracted.
Calculus - calcified plaque - on an extracted molar tooth. This is a bacterial colony and source of infection in your gums and the rest of your body.
Extract this tooth. It is broken and cracked below the gums. The inner pulp chamber is filled with tooth decay cavity.
This patient presented with a loose upper fixed porcelain metal teeth bridge and asked for it to be recemented. There is obvious dental decay on the teeth abutments around composite post & cores. There was not a reasonably established occlusion for this dental bridge. This needs comprehensive care. The patient was referred elsewhere for dental care because she insisted on keeping that bridge.
Internal and external resorption in a maxillary molar tooth. This tooth is hopeless and should be extracted.
The upper right central incisor (#8) was very loose and the patient wanted to try to save it. Pictures show how to try to save a possibly Hopeless tooth. 1) Upper right central incisor (#8) has extruded - grown longer - and moved labially (toward the lip) and a tooth gap space has occurred between the front teeth. 2) This x-ray shows severe bone loss. The black dotted line shows the location for a potential root resection and root tip extraction if necessary. Scaling was performed after the splint was placed and the patient will return in three months to reevaluate periodontal gum healing and the potential need for the root resection. 3) Palatal photo of the splint between teeth #'s 7 - 9. 4) Post-op view. Same day. Notice the diastema - tooth gap space - was closed with bonding to hide the splint and the incisal edge of #8 was reduced.
Before and after pictures of a surgical extraction of a hopeless upper first molar tooth. 1) Tooth #14 with extensive subgingival dental caries - tooth decay. 2) Soft tissue elevation. 3) The tooth socket after the extraction. 4) Sutures.
Extraction of a hopeless broken tooth cracked during an accident. 1) The initial x-ray showing the three teeth bridge and severe damage to the second premolar tooth. 2) The second molar showing furcation involvement and thickening of the periodontal ligament space around the mesial root. The second premolar and the mesial root of the second molar were extracted. 3) Intra oral photo following healing. The patient was informed regarding the long span and declined dental implants. He wanted a new fixed teeth bridge anyway. 4) Radiographic healing of the distal root of the second molar after six weeks. The lesson here is the value of salvaging individual roots of molar teeth.
The top radiograph x-ray shows severe periapical pathology around the mesial and distal roots of this hopeless mandibular molar tooth. The bottom xray shows the same location after tooth extraction.
Extraction pictures of a hopeless molar tooth due to a severe periapical infection. 1) Xray show severe periapical pathology around both the mesial and distal tooth root tips. 2) Buccal fenestration around the mesial root following a vertical incision and flap. 3) The extracted mesial root with the noted pathology. 4) The extraction site.
Extraction pictures of tooth #30 due to severe periapical pathology - infection. 1) Sectioning - cutting - of the mesial and distal tooth roots. 2) Removal of the mesial root. 3) & 4) The tooth extraction site.
Full mouth oral reconstruction of a dental phobia patient with many hopeless teeth. Initial visit pictures. It is important to determine what teeth, if any, may be saved at least temporarily. It is easier for a patient to emotionally adjust to a temporary prosthesis that has at least some amount of retention provided by natural tooth abutments. The teeth chosen were #6, 11, 22 and 28. The decision to fabricate a removable immediate partial denture, rather than a fixed lab-processed temporary bridge, was determined by the particular weakness in the gums around tooth #28. The patient was informed that the immediate prosthesis was to be used for the healing phase and that the four remaining abutments, particularly #28, might be subsequently extracted.
Full mouth oral rehabilitation of a dental fear anxiety patient with many hopeless teeth and severe infection of the gums. Initial before and after pictures: two visits.
A hopeless tooth that should be extracted. 1) Picture of tooth #18 shows gingival gum tissue growing into the space previously occupied by tooth structure. 2) Xray shows extensive dental caries - tooth decay - extending below the surrounding gums and bone.
This oral reconstruction involved the extraction of many hopeless broken cracked teeth and severe infection of the gums.
Selective extraction of hopeless teeth during an upper reconstruction. The initial treatment plan considered saving #'s 6, 7 and 9 while extracting #'s 5 and 8. During the surgery, #5 was considered more stable than #6 so #5 was retained and #6 was extracted. The retained teeth will be used to support a fixed temporary bridge until subsequent dental implants heal.