Daryl E. Malena DDS  Periodontics
10838 Old Mill Road
Omaha, Nebraska 68154
402 330 4100

There was a time when many dentists expected their patients to lose all of their teeth by middle age, and they did not try very hard to keep problematic teeth after the patient was maybe thirty years of age.  Extractions were a very reliable way to solve dental problems.  Things have changed.  Most of us can keep our teeth "forever," but some of us were treated during part of our life with that old fatalistic philosophy.

The result is that we have many patients that are missing teeth, sometimes in odd patterns that are hard to restore.  In addition, only recently have we paid much attention to what sort of empty spot (known to dentists as an edentulous ridge) will be left after an extraction.  Some extractions (due to the infection present or the difficulty of the extraction) leave behind large depressions in the bone and gingiva that complicate aesthetic replacement of the tooth.

A typical example is the loss of an upper front tooth after a traumatic accident or a serious infection.  When the layer of bone on the outside of the tooth is lost, the bone heals with a concavity.  When a bridge is constructed to fill the space, the artificial tooth (known as the pontic) must be extended much longer than the other front teeth in order to touch the ridge and avoid a food trap.

This problem can be avoided by using socket preservation procedures during the extraction, or can be remedied later using ridge augmentation surgery.  In some cases bone grafts are used, but in most cases a piece of the patient's own deep gum tissue is taken from behind the last tooth (where the gums are particularly tough and there is very little post surgical pain) and placed under the gums in the indentation area, restoring the collapsed area to its original shape just like before the tooth was lost.

The result is that dentist can now place an artificial tooth in the space that is exactly the optimal length and cannot be detected in your smile. 

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