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

dental implant abutment

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.

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.

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

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

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7 thoughts on “Wisdom Teeth Extraction/Coronectomy With Simultaneous Baby Tooth Dental Implant Replacement -Case Example

  1. 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?

    1. RamseyAminDDS Post author

      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!

      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,

  2. 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?