WHY DOES MY ENDODONTIST DO EXTRACTIONS?
There are several clear benefits of working with endodontists who are comfortable with extractions: (1) If a tooth is found to be non-restorable during treatment due to a severe crack or fracture, we can immediately remove the tooth while they are already numb without having to send the patient to another dentist who may not be able to see them for several days (2) It allows us to be somewhat ‘unbiased’ with regards to recommending either RCT or EXT treatment options. However, comfort with extractions also allows us to increase our surgical repertoire to provide patients with more options. This case represents a unique presentation of a failing RCT that (a) could not be retreated due to a separated file in a curved MB root, (b) could not undergo apicoectomy due to lesions on all three roots and its location in the arch, and (c) made for a poor location for an implant due to the minimal distal supporting bone provided by a partially impacted wisdom tooth. One ‘last resort’ option remained: Intentional Reimplantation. Of course, a patient has to be prepared that if the tooth fractures or cracks on the way out, it will not be replaced. However, in the right setting of an informed patient without great alternatives, a somewhat conical root, and an experienced endodontist who can competently complete atraumatic extractions, this option can provide a fantastic outcome for minimal investment. In the case illustrated below, apicoectomy was completed in the surgeon’s hand in less than 10 minutes (minimal extraoral time is essential to preserve PDL cell vitality and avoid ankylosis) while using gauze soaked in Hank’s Balanced Salt Solution. The tooth was replanted and no additional stability measures such as splinting or sutures were required due to the socket shape. Over the past month, this patient is now entirely asymptomatic and has physiologic mobility of the tooth without any deep periodontal pockets. The ceramic crown debonded during extraction and has since been re-cemented – again minimizing expense to the patient. Recall CBCT updates will be taken in the coming years.