I Have Vertical Fracture on my Upper Bicuspid As a Result of Post Insertion & an Abscess Under Tooth?

I have been to different dentists and they all have different opinions. They all suggested that I must extract and then they all differed in opinion about what to do next. One dentist suggested that we must place bone graft in the socket after extraction to prevent shrinkage of the bones. Another suggested once I place the bone graft the bone will be infected so the best treatment will be to remove the abscess & make an incision then place a bone graft and then insert an implant. what to do?

Doctor Answers 4

Vertical root fracture and abscess, what to do.

There is no question that the tooth cannot be saved and must be extracted. The question is what next. In general the best replacement is a dental implant ( a fixed bridge is also an option). However, for it to look good and be stable for many years, there must be a good bone foundation. Likely the abcess has dissolved some bone and depending on the size and location of the abscess, it may need to be cleaned out and grafted (either at the time of extraction or at a later appointment). How do you decide? Find a good Periodontist (prefer a Board Certified Periodontist) that has lots of experience on this and go with their recommendation. There are going to be differences on opinion as to how to stage the abscess debridement and graft. You can end up with a good result either way with an experienced surgeon.

I would not recommend to have this done by a  general or cosmetic dentist since their specialty is not implant surgery. Then, have the abutment and crown done by the general/cosmetic dentist. Both the general and periodontist have to be experienced in implants and must be in good communication with each other to know what type of implant and correct placement. BTW, an oral surgeon is the other specialty that can do an excellent job with the implant surgery, however my feeling is that the periodontist has more experience dealing with esthetic issues of gums so if the area shows when you smile, I may favor the periodontist over the oral surgeon.

Good luck

Dr. T

Miami Beach Dentist

Vertical fracture what to do?

No easy answer unless I see a radiograph and do exam but all options are remove and follow with graft then implant, fixed bridge, removable bridge, The question on whether the bone graft is needed and if so when should it be done depends on the clinical conditions good luck Kevin Coughlin DMD, MBA, MAGD    CEO Baystate Dental PC

Kevin Coughlin, DMD
Springfield Dentist

Treatment of a vertical fracture

It is true that a severe vertical fracture means the tooth will have to be extracted.  What to do next is a very good question.  An implant is often the best way to replace the missing tooth, but make sure you are presented with all the options to make the best decision for you.  If an implant is agreed upon, then the question is how to prepare the site for the implant.  An infected site is often better left to heal before an implant is placed.  Whether there is an active infection or chronic infection would determine whether any type of bone grafting can be done immediately after the extraction. Also, the amount of remaining bone after the extraction would also direct the type of bone graft.  To make a decision would require a clinical decision based on radiographs and examination.  It is my experience to take a more conservative route in these case. Find a dentist who has the experience and expertise to make the best judgement and ask a fundamental question -what would he or she do in their own mouth.

Michael Dorociak, DDS
Sarasota Dentist

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What To Do with Vertical Fracture on my Upper Bicuspid As a Result of Post Insertion & an Abscess Under Tooth?

When you have a vertical fracture in your tooth, it almost always means the tooth cannot be repaired and will have to be removed.

The final decision of whether to place any bone graft, or the timing of when to do it, is solely in the hands of the surgeon or implant dentist who you choose to do the treatment.

The answer is MANY different approaches all work. In my opinion, it comes down to that individual practitioner's overall success rate. There are theoretical reasons why one approach may work better than another, but it doesn't always make a real difference.

Like ANY sort of surgery or cosmetic dentistry treatment, find someone whom you have a lot of confidence in, make sure they know your preferences and concerns, and then that they have made a plan for you that incorporates all of that.


These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.