28.10.2019
Between the ages of 6 months and 3 years, a child grows 20 baby teeth, after which the period of permanent teeth begins to appear. Despite the fact that the growth of molars is almost painless, the process requires control and attention from adults. What do parents need to know about changing teeth in children?
Should wisdom teeth be preserved?
We think yes.
Although wisdom teeth are not involved in the process of chewing food, they can still benefit a person. There must be clear medical indications for their removal. And now we will provide you with another proof of the benefits of your own teeth-eights. Our patient Kim is about 20 years old, she is from Korea and lives in Moscow, as her parents work at the Korean embassy. I contacted the German Implantology Center due to inflammation of tooth 4.6 – the lower right six. The tooth was destroyed
, an abscess developed. There was a temporary filling on the tooth (placed in another clinic):
Where a temporary filling was placed, she was told to remove the tooth. That's why Kim came to us with one simple goal - to atraumatically remove the six, which began to greatly bother and hurt her. After doing a CT scan and looking at the tooth, we offered her an option, which, upon hearing, Kim at first did not believe her ears. Our proposal was to remove the six and immediately in its place... transplant its lower right wisdom tooth! This is called autotransplantation surgery.
Wisdom tooth transplant as a way to replace a defect
Of course, Kim was very surprised, but we showed her photographs of successful operations (and we have all of them successful), apparently our persuasiveness and the patient’s desire played a positive role in making the decision to transplant the eighth tooth. She was happy and agreed to the operation.
Moreover, in this case we did not even have to make a stereolithographic model of the tooth, since all surgical procedures (extraction and transplantation) were performed on the very first day of her visit to our clinic.
Dental transplant surgeries typically require several days of preparation, as we describe in the following clinical case study. But in this case, taking into account the current clinical situation and relying on our many years of successful experience in tooth transplantation, we were able to transplant tooth 8 into the place of tooth 6 as quickly as possible. We had all the indications for current dental transplantation.
The donor was an impacted (completely hidden under the gum) wisdom tooth 48. In fact, as we joked, it was a neighbor tooth to the problematic six. That is, the tooth grew and grew for 20 years, waited in the wings, and that hour struck! Now this donor tooth is for another 30 years
at least he will live in a new place.
If you look at the sixth tooth from the side, you can see bluish, literally purple gums
:
This color of the gums is due to the developed inflammatory process. The patient developed destruction of bone tissue against the background of advanced periodontitis. There was a crack in the root of the sixth tooth.
What is the difference between implantation on the upper and lower jaw?
Features of the operation from below
Implantation of the 6th tooth from below is performed using a two-stage method with delayed loading. The implant is implanted using the patchwork method. The crown is installed on the abutment after the artificial root has healed (after 2-4 months). Features of implantation are associated with the anatomical structure of the mandibular structures:
- high jaw bone density - the implant takes root faster, its good primary stability is achieved;
- bone tissue is stronger, therefore it decreases more slowly than in the upper jaw;
- the volume of the mandibular bone is anatomically higher - there are more opportunities to replace the lower tooth without tissue expansion;
- absence of sinuses - there is no risk of injuring the membrane of the maxillary sinus during implantation.
But the trigeminal nerve passes through the base of the lower jaw; if the bone atrophies, it can be damaged (if the technology of the implantation protocol is violated).
Installation of the implant from above
Implantation of the first molars of the upper jaw also has features associated with the anatomy of the jaw structures. The upper teeth are located close to the sinuses (maxillary sinuses), damage to which is accompanied by serious consequences. The maxillary bone is looser and thinner, so it decreases very quickly, and implants take 1-2 months longer to take root than in the lower jaw.
- The choice of method for implanting first molars is a two-stage protocol with a break for osseointegration of the titanium root. The average healing time for upper jaw implants is 4.5 months.
- Since the classical protocol requires sufficient volume and good quality of bone tissue, treatment is often complemented by osteoplastic surgery (sinus lift).
- When making prosthetics, the increased mesiodistal space and the distribution of occlusal forces are taken into account.
The difference between transplanting your own tooth and implantation with a dental implant
By the way, for your transplanted tooth, the presence of an inflammatory process in the soft and bone tissues does not matter, because all the tissues there are their own and, naturally, the body will protect its transplanted tissues. That is, the body does not treat the transplanted tooth as “friend or foe,” which always happens in the case of tooth implantation with a titanium or zirconium implant.
If there is an inflammatory process, an artificial implant cannot be placed in this place. And you can put your own tooth, because it has the so-called. the ligament of the tooth that has all the cells that will fight.
Naturally, after the tooth extraction, we processed everything as much as possible, carefully cleaned and rinsed it.
In this photo we have begun to treat the wound. It can be seen that there was an inflammatory process in the gums, the bone tissue was partially but severely destroyed. Signs of bone tissue destruction are clearly visible on computed tomography:
By the way, even if the bone tissue is destroyed, when we transplant our own teeth, we do not need bone grafting; there is no need to replant additional bone. And that's why. The tooth itself nourishes and regenerates. Even if there were no front wall of the tooth, if there were no vestibular buccal wall, if you transplant such a tooth, then it is restored from its ligament, even the bone grows.
Therefore, if there is a choice between transplanting your own tooth and implanting a dental (titanium, zirconium) implant, it is better to opt for transplanting your own tooth.
Let's begin atraumatic wisdom tooth removal
In 40 seconds
We made an incision in the area of the donor tooth, which we planned to remove and replant in place of the previously removed six. We carefully removed the wisdom tooth, placing it in a saline solution for a short time:
Many people wonder: do wisdom teeth have roots? Yes, of course there is – this is a molar. We draw your special attention to the fact that this wisdom tooth 48 has not yet finished growing its own roots, its maturation is not yet complete. The growth zone of the root of the lower wisdom tooth is preserved and this tooth subsequently, after 2 weeks, does not require nerve removal! That is, it not only grows in, but also completely becomes accustomed to its nerve.
a powerful ligamentous apparatus he has.
, which provides high survival potential. Indeed, this tooth has taken root, and besides, it has a living nerve.
Transplantation of a wisdom tooth into place 4.6
The donor tooth was clearly placed in the place of the problematic sixth tooth. It was as if he had been there all his life: ideal external dimensions, the wisdom tooth was transplanted to the place of the removed one without any external grinding. Ideal autotransplantation operation.
The implanted tooth is tightly sutured
to ensure maximum tissue contact with each other and a normal healing process.
Why does a person's teeth change?
The structure and development of the dentition in different animals differs significantly from each other. In vertebrates and some species of reptiles, for example, teeth change several times in their lives, and over time, a new one grows in place of the lost tooth; in rodents, permanent teeth immediately grow. This is due to the characteristics of the body, residence and nutrition of representatives of the animal world.
There are several species of mammals whose teeth change once in their lifetime during childhood. This is necessary not only for the growth of the body, but also for survival - after the baby stops feeding on mother’s milk, its life largely depends on the capabilities of the dental apparatus. Humans can also be classified as mammals in this category, so changing teeth is an integral process of growing up for them.
After autotransplantation 2 weeks
Patient Kim came to us after 2 weeks
for medical examination and suture removal:
Nothing bothered her anymore. The tooth had acceptable physiological mobility. The gums have become lighter. Of course, all the purple color is not gone yet, but she has already become more pink.
Pay attention to the white area - this is not pus, but fibrin plaque, which we will talk about in more detail below.
The picture shows that the donor tooth has clearly positioned itself in the position of the extracted tooth 46:
Our Kim has a new six molar. Both the patient and the medical staff of the Research Center are very pleased with the outcome of the tooth transplantation operation.
How are baby teeth different from molars?
A human tooth consists of three main parts: the visible part (crown), the root, which is recessed into the gum tissue, and the neck, located between them. Despite the fact that the general structure and functions of primary and permanent teeth are similar, there are still differences between them:
- the surface shade of temporary teeth is white, while permanent teeth are yellowish;
- the tissues of the molars are denser and harder, and the pulp is much larger;
- the shape of the milk teeth is flat and wide, the molars are quite long (the width is significantly less than the length);
- The roots of baby teeth are thinner and shorter than those of permanent teeth.
During the process of loss of temporary teeth and the appearance of permanent teeth, the child’s jaw actively grows, and by the time it ends it reaches an adult size - thanks to this, 32 permanent teeth grow in place of 20 temporary teeth.
About fibrin and fibrin plaque
Fibrin
- a high-molecular, non-globular protein formed from fibrinogen, synthesized in the liver, in the blood plasma under the action of the enzyme thrombin; has the form of smooth or cross-striated fibers, the clots of which form the basis of a blood clot during blood clotting. Thus, fibrin promotes rapid wound healing by forming fibrin plaque.
Fibrin plaque
- a natural phenomenon that occurs in the oral cavity in the area of surgical intervention (at the site where a tooth was removed, stitches were applied, etc.). It occurs on the 3-4th day after surgery in the oral cavity. And this is one of the normal and inevitable stages of healing of a hole covered with a blood clot. This is followed by tissue restructuring, covering the wound with protective epithelium and restoration of normal mucosa.
Patients often confuse fibrin plaque with pus, causing them to worry and call their dentists.
Why does fibrin plaque occur?
Healing of a wound in the oral cavity occurs in a moist environment. If you have a cut on your skin, once the bleeding stops, the wound will be covered with a scab. We all know from childhood that this crust cannot be torn off. A blood clot covered with fibrin plaque is essentially the same “crust”, only in the mouth. And you can't touch her either! Otherwise, the healing process will take longer and the result will be less favorable.
There is no need to rinse out fibrin plaque!
After tooth extraction, tooth transplantation or dental implantation, intensive mouth rinsing is contraindicated, otherwise you may rinse out blood clots and fibrin plaque. As a result, painful sensations will appear, and the wound healing process will be worse.
Therefore there is no need to rinse
, and especially antiseptic and refreshing rinses, which often contain alcohol. However, the mouth can be washed. Make a kind of bath to wash away food residues. For this, a solution of chamomile or even simple black tea is suitable, which you just need to take into your mouth, hold for a while on the injured area and carefully spit out.
