Extraction of a non vital tooth under biologic protocol includes complete removal of the periodontal ligament, debridement of any protective calcium perimeter in the bone, removal of necrotic tissue from the extraction site, insertion of platelet rich fibrin (PRF), and administration of post-extraction ozone. We are able to extract most teeth for existing patients here in our office, but there are cases better referred to the oral surgeons with whom we work on a consistent basis. Wisdom teeth, teeth with sinus involvement, extremely brittle root canals, teeth with curved roots, and teeth fractured below the gum line are examples of referral situations. If you are not a current patient, we will refer you to these oral surgeons as well.
Biologic Extraction Protocol
The biologic extraction protocol involves non-traumatic removal of the tooth, removal of the periodontal ligament, and special post operative healing modalities. Once the tooth is removed, the periodontal ligament and potentially up to one millimeter of spongy bone in the socket is removed via a #8 or #10 long-shanked surgical round bur. A bur is used along with manual removal of the PDL because studies show that manual scraping alone is not enough to clean the socket thoroughly and can even push bacteria and toxins back into healthy bone, potentially resulting in lack of primary healing and in a greater chance of recurrent infection. Removing infected bone and/or the surrounding calcium-dense wall takes the socket down to good, bleeding, healthy bone, promoting natural nutrient flow into the area and waste flow out.
Expect to bleed slightly longer with a biologic extraction. Bleeding helps remove residual infection and begins the healing process. If you still experience a trickle of blood after an hour, place a cool, wet, black tea bag over extraction site, clamp gently, and hold in place for a half hour to help the clot to form.
All teeth have a periodontal ligament (PDL) composed of collagenous bundles, loose connective tissue, blood, lymph vessels, and nerves. The PDL helps hold the tooth in place and functions like a shock absorber. When you bite down and chew, the PDL protects the tooth from shattering by compressing a fraction of a millimeter like a spring. It is standard of care for a traditional oral surgeon to assume that the periodontal ligament adheres to the tooth and is therefore always removed during an extraction. Sometimes it is. Sometimes the PDL remains in the socket.
If left in an extraction site, the PDL's continued presence prevents biologic recognition of the absence of the tooth; bone cells will not proliferate and migrate through a membrane intended by nature to define growth limits of the jawbone.
If the tooth to be extracted is a re-infected root canaled tooth, the PDL itself will inevitably retain infection and may present with a calcium-dense wall around the abscess that must be debrided, perforated, or roughened at the extraction visit to facilitate blood flow for post-extraction healing.
A note regarding extraction of root canal-treated teeth:
Radiographic radiolucencies are abscesses, often addressed in allopathic dentistry by referral to an endodontic specialist for performance of root canal therapy. Biologic dentistry, however, recommends extraction of the tooth unless patient is just not ready emotionally to lose a tooth or is mid-orthodontic treatment, etc., in which cases a root canal can be performed as a temporary procedure. For more information, see the video documentary, Root Cause, or read the book, Hidden Epidemic, by medical doctor, Thomas Levy. Both are available through Amazon.
Platelet Rich Fibrin (PRF)
Platelet rich fibrin is created from a small sample of blood drawn from the patient right before a procedure. The blood is spun down in a centrifuge to form a gel that is packed with the patient's own healing and growth factors. PRF is used effectively in biologic dentistry instead of traditional bone graphs for procedures such as extractions, implant placement, and periodontal / cavitation surgery.
Oxygen-Ozone and Healing Cocktail
We recommend a post-extraction healing injection with medical-grade oxygen-ozone, preferably the same day or soon after to sterilize the area. Medical-grade oxygen-ozone gas creates an oxygen-rich environment that induces a positive, multi-factorial, biochemical/physiologic change in affected tissues. Ozone is one of the most powerful sterilizers in the world with the ability to kill/neutralize bacteria, viruses, fungi, mold, parasites.
Ozone injections are paired with therapeutic healing injections of procaine, B12, folate, and a combination of homeopathics such as lymphomyosot to promote lymphatic drainage and traumeel / zeel to address acute and chronic inflammation respectively. The combination of injections delivers nutrients, clears toxins, upregulates the immune system, stimulates lymphatic flow, and promotes overall healing.
Simple After Care Instructions
-Place gauze over the extraction site and bite firmly. Replace gauze as needed for 30 minutes or until bleeding ceases.
-The anesthetic will wear off in a few hours. Be careful not to bite your lips, tongue, or cheek while you are numb.
-For at least 24 hours, AVOID the following: smoking, drinking through straw, blowing nose, excessive spitting, vigorous rinsing, hot foods/liquids (so as to avoid creating a dry socket by dislodging the forming blood clot and so as to avoid prolonged bleeding).
-Other than natural remedies indicated by your health provider, use only NON aspirin pain medication (Tylenol, Motrin, Advil) to alleviate discomfort as may be needed.
-After 24 hours, begin to rinse gently with warm salt water. Combine ¼ teaspoon salt and 1 cup water, and rinse every four hours.