Wisdom Teeth Extraction/Coronectomy With Simultaneous Baby Tooth Dental Implant Replacement -Case Example

Wisdom Teeth Extraction/Coronectomy With Simultaneous Baby Tooth Dental Implant Replacement -Case Example

Wisdom Teeth Extraction/Coronectomy With Simultaneous Baby Tooth Dental Implant Replacement -Case Example

IMG_1137Can you take out your wisdom teeth and place an implant at the same time? I often hear this question. Yes!!! This is a common procedure for a younger patient who has a baby tooth well into their 20s. Oftentimes baby teeth cannot be saved and need to be replaced with a dental implant since the permanent one was missing from birth. We call those “congenitally missing” teeth.

In this case, this young 24-year-old man came to me with wisdom teeth that continued to bother him and flare up occasionally. He also had a baby tooth in the upper jaw that was fused to the bone. This fusion into the bone is called ankylosis. Ankylosed teeth are very difficult to remove because they don’t have a ligament between them…so they don’t move at all. He did not like the way his smile looked with the tooth not being level with the rest of them and knew that the baby tooth was in bad shape and decaying.


IMG_1141
The plan was too extract the baby tooth and simultaneously place a dental implant at the same time of extraction and do a bone graft into the voids around the socket. While he was under IV sedation, two wisdom teeth are going to be treated at the same time. One of them on the upper left was extracted in a typical surgical fashion. This means that the gum is lifted, and the tooth is removed sometimes by sectioning it and/or by minimal bone removal.

His lower wisdom tooth is very unique. If you notice, I only removed two of the four wisdom teeth. In fact, I really only removed 1-1/2 teeth. On the lower right, a procedure called a coronectomy was completed at the same time the dental implant was placed with the baby tooth extraction and the wisdom tooth extraction on the upper jaw.

Dental implant baby tooth (1) The nerve that gives sensation to the lip, teeth and chin is directly below all of the lower teeth and was touching the wisdom tooth. In his particular case it would’ve been too risky to remove the entire tooth and cause a possible permanent numbness or nerve damage from the removal.

A coronectomy allows the head of the tooth to be removed and purposely leave the roots behind. It is a procedure that is accepted in modern oral surgery but is not that common. In his case, avoiding a nerve injury was very important so only part of the tooth was removed.

It is very rare for the roots to cause a problem later in life; they usually just sit under the bone forever. Very rarely, a complication can occur where the roots begin to move and need to be taken out, but at least it is much easier and less risky because the root is no longer touching the nerve. Nerve injury is also a risk of having a dental implant or bone graft on the lower jaw.

Dental implant baby tooth (2) The dental implant was allowed to heal for four months. I restored this case with the prefabricated titanium straight contoured abutment and layered zirconia crown. This provided the patient with an excellent profile and reproduction of his original tooth. If your situation is similar, consider extraction of the baby tooth and placement of the implant at the same time. Sometimes placing the baby tooth implant has to be done in coordination with orthodontics because most baby teeth are bigger than the adult’s teeth in the premolar region.


RIGHT
before-ankylosed baby tooth on upper impacted wisdom teeth on lower
IMG_6538

final dental implant crown
final dental implant crown
dental implant abutment
dental implant abutment
after coronectomy on lower wisdom tooth and placement of dental implant for baby tooth
after coronectomy on lower wisdom tooth and placement of dental implant for baby tooth

Ramsey A. Amin, D.D.S.
Diplomate of the American Board of Oral Implantology / Implant Dentistry
Fellow-American Academy of Implant Dentistry

10 Comments

  1. Cijoy K Jose

    Sir,

    My lower wisdom tooth is in an extreme decayed stage…. Can I remove it and place an implant in that place.. because I want my wisdom tooth replacement.. i had a brace on my teeth .. so I have only 3 teeth after my canine if my wisdom tooth go away. Also my upper wisdom tooth will hit my lower gum tissue.. upper part also have 4 tooth after canine due to the brace .. because my 4 teeth extracted to do the shifting process… Before brace i have had an extraordinary dental health and teeth quality…All of my wisdom tooth came out properly in the age of 18… I am now 25 … Also is there any way I can regrow my tooth.. any discoveries???

    February 5, 2018 at 4:35 pm Reply
  2. Moumita Dey

    Story : In my early age I lost one wisdom tooth ( Lower Jaw) . That space was occupied by the next tooth. Now I need to extract that tooth also.

    Question : Is it possible to have one implantation with a bigger crown ( Bigger than One tooth but smaller than two tooth size ( together) )

    December 29, 2017 at 11:41 am Reply
    1. RamseyAminDDS

      It is possible but if you overload one implant with a larger tooth it is likely the implant will fail after a few years. You may require two implants rather than one.

      December 31, 2017 at 3:42 am Reply
  3. Linda

    Hi Dr. Amin,
    My dentist wants to extract two wisdom teeth upper and lower left side (I already had the other two out when I was a teenager). The wisdom teeth are not hurting me and he says that they are so decayed that they need to come out (then he’s going to put a bridge in our numbers 12 13 and 14 )and I’m fine with that -looks pretty good, the temporary anyway. My question is, should I have these wisdom teeth extracted because I have a bad case of tinnitus from a previous dentist 2 months ago that’s driving me to be stressed every day. My internist says I should go ahead with the extractions and maybe that would help the tinnitus . When I press on my tooth #14 (root canaled this summer), it changes the frequency & volume & seems to lower the annoying sound. Should I listen & get them extracted. I’m afraid of more nerve damage! Thanks for any advice on this.
    PS is there anything that can be done to the nerve injury of #14 before it becomes part of a permanent bridge with 13 & 12?

    October 21, 2016 at 1:51 am Reply
    1. RamseyAminDDS

      Upper wisdom teeth do not have any main nerves. Only lower wisdom teeth run close to a big sensory nerve. You should be good to go!

      October 22, 2016 at 2:33 pm Reply
      1. Linda

        Thank you Dr. Amin. Forgot to mention, I’m 62, if age will matter on wisdom teeth extractions and it was #19 that was reroot canaled & has a new permanent crown (temp glue though) & it changes the frequency pitch when I press on it with my finger. That’s why I’m afraid it’s my nerve. Thanks for any insight,
        Linda

        October 22, 2016 at 3:33 pm Reply
        1. RamseyAminDDS

          Because they are uppers it should still go smoothly hopefully.

          October 23, 2016 at 12:06 am Reply
  4. Mark

    I would like to remove the 9 teeth on top and the 14 on the bottom.
    Put two pegs on top and two on the bottom for a set of clip in but like the roof of my mouth do not want a plate.
    Is this possible ?
    How much?

    January 7, 2016 at 4:02 am Reply
    1. RamseyAminDDS

      Possible. But bad idea. Read this to help you understand a bit more.
      the post “How Many Dental Implants Do I Need Under My Denture?”
      https://www.burbankdentalimplants.com/how-many-dental-implants-do-i-need-under-my-denture/

      January 7, 2016 at 4:16 am Reply
  5. Sean

    Excellent post!!

    September 9, 2015 at 7:49 am Reply

Write a Comment

Monica D.
Monica D.
December 29, 2020.
There aren't enough words (and I have a lot of words) to tell you how grateful I am to have found Dr. Ramsey Amin and his wonderful staff. I had an enormous amount of bone loss and I was hopeless after being treated by a different doctor for two years. I had multiple procedures such as gum graft, extractions, and a sinus lift. After all of that, the doctor released me and told me he could not help me any longer. He sent me to a large teaching hospital - who also had no idea how to help me. I was terrified and embarrassed. I had been missing teeth due to those procedures since 2017. That sent me out on a journey of meeting with no less than five different dentist/oral surgeons. Most of them shamed me for the bone loss and wondered what I had done to cause this. In reality, I had done nothing. The bone loss is my body's immune system fighting me, as well as hereditary traits. In fact not only was I having difficulty being able to have implants, I also had so much bone loss that I was also not a candidate for dentures. I researched "what to do when you have bone loss and can't get implants" and I found Dr. Amin's website. Then I researched him, read his reviews, watched every one of his You Tube videos. I called and got an appointment, and kept going to consultations with other providers. I had long since stopped smiling and being social. Missing teeth and the shaming was affecting my life so adversely. When I met with Dr. Amin for my consultation he was ready. He had all of my records and had already reviewed my scans. But more than that, he genuinely wanted to get to know about my life. He was/is authentic, kind and extremely professional with so much success and experience in difficult cases like mine. He worked up a treatment plan & I came back two weeks later to discuss my options...and the journey began. I have had three procedures under IV sedation, no pain, no narcotics needed for aftercare. Dr. Amin is a consumate, experienced oral surgeon who cares about your health & understands your fears. He communicates every step of the way and will provide you with all the information you need to make a decision to improve your health. I am still working toward my end goal, and we had to zig from traditional implants and zag to zygomatic implants instead...which is the reason I chose him in the first place. If there was nothing else that could be done to get me healthy & smiling again, I knew he would have that option to help me. And of course 2020, the year of CV-19. Don't worry, Dr. Amin & his staff follow all health & safety protocols. This review is long, because it is important you know my journey, so you might understand how fortunate I feel to be healing. I'm torn, because this place is like a great restaurant, I want to shout from the rooftops how great it is, how great he is. And at the same time, I want to keep this all to myself. I come 75 miles each way to see him. I know people travel from all over the world for his expertise. Do yourself a favor, have a consultation. You won't regret it. Dr. Amin is amazing and so is his staff.
Jennifer B.
Jennifer B.
December 18, 2020.
I cannot speak highly enough of Dr. Amin and his professional staff. I have to start off and say that I am absolutely TERRIFIED of the dentist due to several past experiences. I found myself putting this off for YEARS until I was referred over to Dr. Amin. I was petrified on my first visit... but he along with his WONDERFUL staff made me feel so calm and at ease. I had quite a bit of work that needed to be done, but we found the perfect plan that worked out for me, and I couldn't be happier. Words cannot express my gratitude to each and every staff member that made me feel safe and comfortable. Dr. Amin was always so attentive in asking if I was ever in pain... and I never was. These are truly remarkable individuals, and I'm so lucky to have a dentist that I can trust. I ABSOLUTELY LOVE each and every one of you! Thank you,
D M.
D M.
December 17, 2020.
I cannot say enough positive things about Dr. Amin and his staff. I originally found them on Yelp about two years ago. I needed an implant, front tooth of all places, and was extremely nervous not only about surgery but about how it would turn out. Let me just say I just adore the staff. Everyone is crazy friendly and the whole office has a very positive vibe. The staff is adorable and always has me smiling by the time I leave. They are all thorough and on-point about what they do, and I truly appreciate it. They are quick to respond to my emails no matter the question, and their appointment reminders are great too. Dr. Amin is very thorough and reassuring, and answered any questions my husband or I had. My regular dentist had questions about the procedure and Dr. Amin's office even reached out to them at my request (my dentist said they never received a call, but Dr. Amin's staff had date, time and notes - love the thoroughness!). After surgery the Dr. called to leave me a message about how it went. Very minimal pain during healing, never any pain during any visits. It took a few tries to get everything just right for the permanent crown (color, etc), but the end result is beyond fantastic! At one point during healing I thought I was experiencing some looseness or wiggling but unfortunately couldn't make it to the office. When I was finally able to make it in the Dr. was so relieved, bless his heart. Luckily it was just a false alarm and everything checked out ok. They're a bit further out from me, but I wanted the best. I sure found it! I wish they were my regular dentist, and I'm looking forward to seeing them again for my check-up which was delayed due to COVID.
Melissa E.
Melissa E.
December 9, 2020.
I found Dr. Amin a few years back after I hadn't been to a dentist in a decade. Many traumatic dental experiences in childhood have made me so phobic that even getting a cleaning was a knee-knocking, heart-pounding trial. But finally I couldn't put off some things any longer. During my first anesthesia session, Dr. Amin replaced five old metal fillings, and during the second he did three more plus a crown. I was completely comfortable, and never felt a thing. Because they were extra-long sessions, I did sleep for about 12 hours after, but the next day I felt just fine. This past week, my back top tooth cracked in half and fell out of my mouth, and a couple days later the crown on the remainder of the tooth fell out too! Despite being nervous about Covid 19, I had to get it taken care of, so I called and quizzed the staff about precautions, which turned out to be even above and beyond what I would have expected. So yesterday I went for the tooth extraction and plug. After they put on the blood pressure cuff and put in the IV, I gradually got a little tired and closed my eyes. I sat there for about 10 minutes and thought Gee, I wonder if they're going to get started any time soon, and a minute later Dr. Amin said "Wake up, you're all done!" That was a short session, and I didn't have the kind of fatigue I did my first time. I stayed up most of the evening. Today, everything is good! I'm taking my antibiotic and eating soft foods, and there is surprisingly little pain now that the numbness has worn off. The tooth site and my cheek are a little sore, and the corner of my mouth, and I have a very slight headache, but nothing to any great level--I'm not even taking the acetaminophen. I feel good, and wide awake. Thanks to everyone at the office for a comfortable and professional job! I really REALLY appreciate you for giving me painless dental experiences!
Tanya S.
Tanya S.
December 3, 2020.
What can I say about Dr. Amin he is the best! I'm so grateful for him. He has literally changed my life and given me the confidence to smile more. I had major restorative dental work done and everything went smoothly. Dr. Amin is very compassionate and he really cares about his patients he made me feel comfortable and cared for. He is very knowledgeable and has a great sense of humor. His office is very clean and they take the patients health and safety very serious. His staff is also amazing they made me feel very welcomed and important. I'm so happy I did my research and found Dr. Amin.  Thank you Dr. Amin and team.
Sheila S.
Sheila S.
November 6, 2020.
Two implants done! Finished all procedures and I couldn't be happier. It's the first time in years I looked forward to going to the dentist. Even during Covid life the staff and Dr. Amin took care of me. There is a possibility I may move to Long Beach but I would still travel to keep Dr. Amin as my dentist.
Allison S.
Allison S.
November 4, 2020.
I could not ask for a more caring, exceptionally knowledgeable dental care provider. He's not just a dentist, but someone who looks after your immediate dental needs and helps you plan and prepare for the future.
Julia R.
Julia R.
October 8, 2020.
I've been going to Dr. Amin since I turned 16 and have been going since. Before going to Dr. Amin's dental office, I had 4 crowns that I was not happy with and dealt with it until finally I asked Dr. Amin and because I  feel comfortable and because I trust him with his work I recently had my crowns fixed and worked on by  Dr. Amin and have never loved my smile the way I do now, I can actually enjoy my pictures, I can enjoy my smile from either angle and that really mattered to me. Thank you so much Dr. Amin still and will be in love with MY smile
Aaron D.
Aaron D.
October 6, 2020.
I've been coming to Dr. Ramsey for about five years and I have to say, he is by far the best dentist I've had - ever. The staff is professional and kind, the office is exceptionally well maintained, and Dr. Ramsey is careful and extremely knowledgeable about current developments and research in dentistry. I recently had a dental implant which was a long process but well worth it. I required a sinus lift as well as a bone graft. The surgery went off without a hitch, I was comfortable and the healing process was quick and without complication. Highly recommend!!
Flo O.
Flo O.
September 21, 2020.
This is my 1st review of Dr. Amin, and in my over 17 years of being with him, my experiences with Dr. Amin and his staff have always been positive.  I don't recall a bad experience with the several implant procedures i have had.  They run an efficient office.  I like that they are proactive and reach out to their patients to remind us of routine care needed.  Dr. Amin's bedside care is impeccable.  They are also technologically up to date in terms of sending out texts as reminders, ability to incorporate any appointment into your mobile phone.  That is certainly a plus.  Keep up the great care!!!