Chapter 21

STRATEGIC EXTRACTIONS

Extraction of a tooth, that obviously cannot be saved should be carried out as early as possible within the treatment plan, allowing healing and associated remodelling of tissues prior to definitive re-restoration. Ideally, nine months should be allowed between extraction and re-restoration.

If the tooth will be replaced with an osseointegrated fixture, a decision must be made on the healing period necessary prior to fixture placement. In non-infected sites the fixture can be placed immediately,¹ but this can make the closure of the soft tissue defect difficult, which is necessary for a saliva tight seal over the fixture. Four to six weeks of healing prior to fixture placement allows epithelialisation of the flap to occur and facilitates flap closure. In the presence of infection it may be best to wait six to nine months prior to fixture placement (see Chapter 33).

Several management options should be considered. For example:

i) No Existing Bridgework, but a Fixed Bridge is Required

1) Prepare the teeth on either side of the tooth to be extracted, or at least two teeth on one side if the pontic will be cantilevered.

2) Make an impression for an immediate insertion provisional bridge.

3) Fabricate temporaries for the prepared teeth.

4) Extract the tooth and insert the provisional bridge.

ii) No Existing Bridgework and Tooth will be Replaced with an Osseointegrated Fixture
(Figs 21-1a–d)

1) The tooth can be replaced with a simple partial denture.

2) Alternatively, following extraction and fixture placement, it can be replaced with an acid etch composite retained bridge. A Rochette type of bridge is preferable to a Maryland, as it is more readily removed by cutting through the lingual composite resin tags. The bridge retention is confined to the palatal surfaces of the abutments. It is removed at Stage II surgery and an immediate temporary crown made on the fixture abutment (Figs 21-1c and 21-1d [final crown]).

iii) Existing Bridgework Requiring Replacement (Figs 21-1e–h)

1) Remove bridgework.

2) Refine preparations on either side of the tooth to be extracted.

3) Impression for temporary bridge.

4) Impression for provisional bridge.

5) Extract the tooth.

6) Insert temporary bridge.

7) Replace temporary bridge with provisional bridge.

8) If the tooth to be extracted is sufficiently sound without pulpal />

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