Page 12 - Dental Practice August 2022

prosthodontic section

WHEN TO SAVE AND WHEN TO EXTRACT

A PROTHODONTIST’S PERSPECTIVE

SACHIN DEEP SINGH

INTRODUCTION
One is often faced with clinical situations of grossly decayed
tooth/teeth. With the success and availability of implant dentistry
the most common approach is to extract such teeth. There is
definitely a lack of understanding of the importance and rational to
make that extra effort to salvage such situations even for a short
period.
This article will explore such situations, attempt to create a
prognosis guideline and provide treatment solutions for badly
mutilated teeth from a prosthodontist’s perspective.
The advancement in adhesive dentistry has now made it possible
for us to look at restorability in a completely new light and that will
remain as the main criteria in looking at various restorative and/or
prosthetic treatment solutions. The goal of restoration is to have a
functional, aesthetic tooth which will be able to withstand the
occlusal loads.
The most important aspect of restoring grossly decayed,
fractured, mutilated teeth is the evaluation of remaining tooth FIG 1 FIG 2
structure in various aspects. The loss of dental tissue and the weak-
ening of the remaining structure present a challenge in terms of
prosthetic rehabilitation.

Following parameters must be evaluated individually and together
in order to access the restorability and longevity of the same.

1. RemAining heAlThy TOOTh STRuCTuRe
The amount of remaining dental tissue namely enamel and dentin
determines the long term success of restorative and prosthetic pro-
cedures. The tooth gets its strength from the truss effect of dentin,
namely the interaxial dentin and pericervical dentin. One need to
evaluate how much of these tissues are preserved and also have
planned prep designs to maintain the tissues as much as possible
(Figures 1 and Figure 2). FIG 3a

2. AmOunT OF TOOTh STRuCTuRe AbOve The AlveOlAR
CReST
The amount of tooth structure above the crest helps the clinicians to
access the “ferrule” effect. The ferrule effect—the need for a 360º
collar 2 mm in height (1.5 mm minimum)—was described by

Article Citation
Singh, S. (2022). When to save and when to extract: a
prosthodontics perspective. Dental Practice, 18(4), 12-15

FIG 3b

12 Dental Practice // July-August 2022 // Vol 18 No 4