Tooth Extractions

Getting the right information prior to getting a tooth pulled out is a smart thing to do. And it can save you a lot of time, energy and money. Let’s get started.

Tooth Extractions

Tooth Extractions a tooth out of a person’s head is not a new concept and is in fact centuries old. Each case differs in difficulty and is dependent on several factors. For instance, ask any dentist and they will agree that a root canal treated tooth is ten times more difficult to remove. The same is true for teeth with crowns, posts, and large cavities. These days, people clench and grind their teeth more than in the past, making the jawbone denser and tooth extractions more difficult.

Teeth extractions in our office involve the use of electric high-torque handpieces, lasers, ozone gas and our patient’s own blood to complete a “biological” tooth extraction. This method involves more equipment and requires more time, but in many cases, it provides a more natural healing process and lowers the chances of infections and post-surgical pain.

How We Remove A Tooth

Tooth Extractions: Above all else, we require a 3D CBCT X-Ray to determine the best strategy to remove the tooth with as little damage as possible; however, some damage and inflammation should be expected with any kind of surgery.  Our goal is to minimize discomfort, symptoms and complications while still achieving thorough debridement, disinfection and complete tooth removal.  A predictable result always begins with proper planning.

To Learn More About 3D CBCT X-Rays Click Here

Another consideration that needs to be taken into account is if the tooth is better off removed in one piece or if it needs to be “sectioned” before removal.  Much like removing a plant or tree from the ground, the number of roots, how fragile the roots, and how strong the ground is all play a vital role in the decision-making process.

Whenever possible, collateral damage should be avoided. One example is when a dentist uses a neighboring tooth as leverage to extract a tooth. Oftentimes the other tooth may already have a crown or weakened enamel.  If this is the case, then proper techniques should be used to prevent unforeseen dentistry.

Another consideration when extracting a tooth is tooth replacement. If the patient wants to have a dental implant, then the dentist removing the tooth should know that at the time of extraction.  If a future dental implant is desired, then extreme care should be taken to prevent the “cheekside” bone from being accidentally removed. This can be a challenge especially if that particular bone is thin or attached to the roots of the tooth. If this bone is damaged and removed, then the chance of having a dental implant decreases significantly and a bone graft may be recommended (at an additional cost).

Should You Get A Bone Graft?

Bone grafts are placed in extraction sockets to preserve the bone or to prevent bone loss. Though it is not always predictable, up to 80% bone loss can occur over the course of a year after a tooth is pulled. Since dental implants are usually the best choice for replacing teeth and are literally screwed into the bone, bone grafts are sometimes recommended at the time of extraction. A bone graft can be harvested from another bone in the same person, or the bone graft can come from another human, another animal, or synthetically made.

Since there are as many types of bone graft materials as there are opinions, our advice is for you to do your research before deciding whether to get a bone graft or not, because it is not always necessary and can be a waste of money. Our clinic prefers for your body to heal naturally with the use of PRF (Platelet-Rich Fibrin).

As one can now tell, dental extraction procedures come in many different forms. The bottomline is, we encourage you to make careful considerations when choosing your dental provider.

Picture Credit: By Coronation Dental Specialty GroupOwn work, CC BY-SA 3.0, Link


How is a Biological Tooth Extraction different from a regular extraction?

Every legitimate dentist has had experience with extracting teeth, but not all dentists are comfortable doing it. In fact, many refrain from doing this procedure and prefer to refer extractions out to oral surgeons, a specialty of dentistry.

A typical tooth extraction process would go:
Step 1 – The tooth is removed as fast as possible.
Step 2 – The site is irrigated.
Step 3 – The site is checked for infected tissue remains and if such is found, this is then scraped off.

Unfortunately, step 3 is a step that is not often prioritized or is even skipped.

A biological tooth extraction involves the use of natural disinfection methods such as ozone gas, and a biological dentist makes sure that the periodontal ligament (PDL) is removed to complete the procedure. If the PDL is not removed and the body heals over this ligament, then bacteria is trapped inside therefore disallowing proper healing inside the residual tooth socket. This imperfect bone is scar tissue that never fully heals into normal bone marrow, sometimes causing an “energy” blockage. In health circles, this is called a “cavitation” or cavitational osteonecrosis. Other names for this kind of infection are neuralgia-induced cavitational osteonecrosis (NICO), ischemic bone marrow disease and osteonecrotic bone marrow disease.

A well-trained biological dentists performs these extra steps to prevent a cavitation when pulling out teeth:

  1. Thorough scraping of the socket to remove the periodontal ligament
  2. Curretting the granulation tissue and soft infected bone
  3. Being careful not to damage important anatomical structures such as sinuses, arteries, nerves and other teeth
  4. Treating the socket with laser to promote bright red blood flow
  5. Applying ozone gas
  6. Using of ultrasonic tools to rid the socket of infected tissues

What is PRF?

PRF is short for Platelet-Rich Fibrin. This is produced by centrifuging our patient’s own blood, to which we draw right before the procedure. The first product we use is called iPRF or injectable PRF. This product has a high number of crucial cells and chemicals that initiate a healing response by the body. It has been shown that some of the cells are mesenchymal stem cells. The other product we produce from your own blood is the platelet-rich fibrin. This component contains fibrin, fibrinogen, and cytokines, which are small proteins secreted during an inflammatory response that mediate the healing process. These cytokines are all naturally in the blood; however, our PRF protocol allows for a higher concentration of these cytokines. Our patients have reported less pain, less bruising, less swelling, and faster healing when PRF is used.

Is it the same as PRP?

Platelet-Rich Plasma originated before PRF. Similar to PRF in that it contains chemicals that initiate healing. The difference is that PRP requires more blood to be drawn and faster spin rates, which may lead to more cell damage. PRF is a newer method to get more cells and cytokines.

Wisdom Teeth Removal

Wisdom teeth, also called 3rd molars, are the last teeth to come out and the furthest back teeth to come in. Most people get them removed as recommended by the dentist, oral surgeon or orthodontist. The reason why they are recommended to be removed so often is because there isn’t enough room for the teeth to come full out. In some cases, they do come out but due to their location, gum disease and decay are common. Many dental professionals also remove them as a preventative measure. They predict that the jaw will be too small to accommodate the teeth so instead of waiting for them to be symptomatic, the professional will recommend the wisdom teeth be removed early, sometimes as early as 15 years old.

The decision to remove the wisdom teeth depends on many factors. In general, we do not recommend removing them unless they need to be removed. At a minimum a CBCT x-ray is required in order to properly evaluate the condition and make an appropriate recommendation.

Before And After

In this case study, a metal crown came off and the patient reported that tooth was sore.  We diagnosed an infection at the end of the tooth.  From the picture one can see that the tooth was decayed and metal corrosion was evident.  

Using our protocols, we carefully extracted the tooth without laying a flap.  After removal of the tooth, we used a low-speed, high-torgue electric handpiece with a round drill bit to scour the walls and remove the soft bone near the apex of the tooth.  After sterile water irrigation, laser energy, ozone gas disinfection, we placed the patients processed blood (the PRF) in the socket and sutured the site up with dissolvable stitches.