We have already discussed the loosening of teeth due to periodontitis in many chapters.

Periodontal diseases are infectious diseases that destroy the alveolar bone which is the main bone tissue supporting the dental organ. Periodontitis is responsible for 40% of dental extractions.

The important thing to remember is that if your upper gums seem to be shorter than they used to be and no longer cover the roots of your front teeth, you probably have bone loss. A radiological evaluation will make the differential diagnosis with a simple gingival retraction without bone loss and an infectious periodontitis. In extreme cases, one or more teeth may be lost.

An abscess, following a vertical periodontal lesion all along a dental root, is a case of extraction of one or more teeth depending on the case.

In this clinical case, bone grafts can be considered to reconstruct the vertical loss of alveolar bone volume (jawbone in which the dental organs are attached). Then, or concomitantly, one or more dental implants are placed to support an aesthetic implant-supported dental prosthesis.

In this clinical situation, the management of aesthetics is very delicate. The retraction of the gum is due to infectious bone resorption caused by periodontitis. The objective is to block the horizontal resorption of the periodontium by sanitation, fill the vertical bone loss, replace the missing dental roots. The gingival contour may not be higher than the general recession on the adjacent natural teeth.

At this level there are two aesthetic strategies:

• Either validate this relative disgrace on the new ceramic dental crowns on implants and create a makeup on the cosmetic ceramic that imitates a false loosening of the teeth. This is often the choice for male patients.

• Or improve dental aesthetics by placing dental veneers on the adjacent natural teeth to have white dental crowns. This is the cosmetic dentistry option generally chosen for female patients.

In the case of a decayed tooth that is too far below the gum line, it will have to be extracted to avoid generating an infection at the end of the tooth root. A cavity, even if treated with a composite or an amalgam, such as a filling, can lead to necrosis of the tooth. If the pulp damage is not treated in time, it will lead to a bone abscess at the root apex. With almost no pain, the infection reaches an extreme stage of bone loss and the tooth will have to be extracted. 

Often, wisdom teeth push the teeth forward and the permanent central incisors overlap. Even with good dental hygiene and the brushing of dental plaque with a toothpaste and an adapted toothbrush, it is frequent to have important interdental caries at this level.

In this case, it is preferable to combine the placement of the implants with the extraction of the wisdom teeth under dental sedation with an anesthesiologist.

Our advice: Even if you think you have healthy teeth, have the reflex to visit the dentist and ask for a 3D radiological scan, the only exam that is exhaustive, that is to say that it diagnoses all the dental pathologies that can go unnoticed with other exams. Your oral health is at this price. 

Iatrogenic dental care is a procedure performed by a dentist to treat your teeth that will have a negative impact on your health. This is typically the case for endodontic treatments that will generate root lesions. As before, the affected teeth can be extracted. The devitalization of teeth is indicated if there is an inflammation of the dental pulp or if there is a necrosis of this one.

We have already discussed tooth loss due to improperly conducted root canal treatment in the chapter “Endodontic Treatment”.

Low-grade pulp necrosis is the most insidious because there are no painful warning signals or they occur too late. These necroses cause peri-apical dental cysts that can be very debilitating, requiring immediate extraction of a smile tooth such as an incisor or canine. Of course, all teeth are affected by this problem, but premolars and molars have less of an aesthetic issue. 

There are many causes of chronic inflammation leading to endodontic necrosis. But let’s mention : dental caries, amalgams, composites, dental veneers, dental crowns or bridge, too invasive and on teeth that are not already devitalized. Various mechanical or chemical traumas, such as shocks or even dental whitening not adapted to the treatment of stains on enamel. 

Agenesis of the permanent teeth is diagnosed at the dentist between the ages of 6 and 11, when the baby teeth are lost. The absence of eruption of the permanent tooth, after the fall of the temporary tooth, highlights this problem and a radiological control confirms the absence of dental germs which very often concerns the permanent lateral incisors.

In this case, an orthodontist will align the front teeth with the help of a dental appliance, and thanks to a space maintainer, the time to wait for the end of the child’s growth, dental implants, with their ceramic crowns, can be placed in place of the missing teeth.

Iatrogenic dental care is a procedure performed by a dentist to treat your teeth that will have a negative impact on your health. This is typically the case for endodontic treatments that will generate root lesions. As before, the affected teeth can be extracted. The devitalization of teeth is indicated if there is an inflammation of the dental pulp or if there is a necrosis of this one.

We have already discussed tooth loss due to improperly conducted root canal treatment in the chapter “Endodontic Treatment”.

Low-grade pulp necrosis is the most insidious because there are no painful warning signals or they occur too late. These necroses cause peri-apical dental cysts that can be very debilitating, requiring immediate extraction of a smile tooth such as an incisor or canine. Of course, all teeth are affected by this problem, but premolars and molars have less of an aesthetic issue. 

There are many causes of chronic inflammation leading to endodontic necrosis. But let’s mention : dental caries, amalgams, composites, dental veneers, dental crowns or bridge, too invasive and on teeth that are not already devitalized. Various mechanical or chemical traumas, such as shocks or even dental whitening not adapted to the treatment of stains on enamel. 

The most important source of extractions of smile teeth such as central and lateral incisors is dental trauma due to a fall. Violent sports, without mouth guards, leading to direct impacts or forward falls lead the patient to consult a dentist in emergency.

There are several cases of dental trauma:

– The teeth are traumatized with bleeding gums: After washing the wound with saline, the severity of the dislocation and the vitality of the tooth must be checked and a retainer must be applied. Then, we check radiologically, with a panoramic X-ray and a 3D cone beam scanner, if there are any fractures or cracks in the roots or a fracture of the alveolus or a crack.

After healing of the alveolar bone the clinical case is reassessed: If the teeth are broken at the root level or the dental crown below the bone level, if chewing is painful, if there is resorption of the root and/or alveolar bone, then the teeth concerned must be extracted and replaced.

Following a violent shock, there may be a traumatic avulsion of one or more teeth of the smile. In this clinical case, reimplantation is always possible, if the tooth is recovered and placed in saline (or even milk).

If the tooth is overbilled or lost, a dental implant is needed to replace it with a ceramic dental crown. A tooth extrusion or fracture can involve any tooth in the smile, such as an incisor or canine in the upper or lower jaw, but also premolars or molars in the posterior sector. The trauma may be accompanied by a fracture of the jaw with or without displacement.