Piotr Roszkiewicz: Hard and Soft-tissue Management Around Broken Teeth
Fractured walls or even whole tooth crowns are quite common in cases of root canal treated teeth with large fillings. Rebuilding supragingival fracture is not a problem, but fractures located subgingivally or below bone level often means that we qualify the tooth for extraction. In the elderly, any extraction is still reasonably well accepted. While in younger patients (20 - 30 years) extraction often is not acceptable. A similar situation exists with deep subgingival decay descending to the bone level, in which it’s impossible make proper conservative restoration and / or root canal treatment due to the lack of dryness or isolation. The use of a laser as an alternative to extraction has not encountered negative feedback from the patient. As a minimally traumatic tool for shaping gums and bone, the laser is an ideal tool for younger patients - when extraction will cause loss of alveolar bone or will be associated with expensive regenerative treatments and implantation. Also implantation over a longer period of time is associated with the risk of bone loss around the implant, with mucositis and peri-implantitis. Controlled "loss" of bones and gums with the laser use is always safer than uncontrolled bone loss, even with minimally traumatic extraction. The doctor’s workload is relatively small and the risk associated with possible complications is practically zero in comparison to the socket preservation and implantation. This involves compromise and a dilemma. How mucosa and bones can be or should be removed? Will it still be possible to make a proper restoration after this surgery? How to reduce the size of the tooth to achieve longevity? How long will the tooth remain?
