Dental Implant After Extraction

Ann, a patient, asks us:
I recently had tooth 31 extracted after it cracked. My periodontist suggests a dental implant and says that I’ll have problems with the tooth above if I don’t. I don’t want one: It is expensive, and seems like a big ordeal.

I know that
there are possible problems.  My dentist thinks that a dental implant isn’t
necessary and is risky.  He says if it were him, he wouldn’t have it and
would manage quite well without the tooth.  (He’s also the one with no
financial interest.)   So, what would I be risking if I were to forego a dental
implant?  What future consequences might I face and how surmountable
might they be?

36 thoughts on “Dental Implant After Extraction

  1. Ann,

    With all due repect, your dentist is ignorant and misinformed. It is this lack of knowledge of dental implants by most GP dentists that plagues dentistry today.
    I myself had that same tooth replaced with an implant and I wouldn’t have considered not doing it. The loss of 31 will cause the opposing tooth to over erupt and render it useless. You will then end up having it extracted as well. Ask your dentist if he restores dental implants. He probably does not. Trust your periodontist and ask him to refer you to another dentist with a more positive view of dental implants.

  2. Many factors needed to be considered.

    Advantages of having an implant in #31:

    1. Keeps the bone around.
    2. Prevents surpraeruption of upper tooth/teeth in contact with #31.
    3. More biting power.
    4. More stable bite if other teeth were not in good periodontal bone support.
    5. If tooth #32 is in function, having implant in #31 prevents mesial tipping of #32.

    Disadvantages:
    1. Cost
    2. Surgery
    3. Multiple dental visits
    4. Potential complications associated with implant surgery and prosthesis

  3. Dear Ann:
    I am also truly surprised by your dentist!!! The loss of #31, aside of the other factors named above, will also mean loss of support to your temporomandibular joint on that side. However, I completely disagree with the second comments. I am a Prosthodontist who also is certified in implant surgery. I place and restore several hundreds of implants a year and the only disadvantage to implants is COST. The surgical procedure for a simple single implant, done by experienced hands, is a half an hour to an hour procedure start to finish, and is just about as traumatic as getting a large filling. The complications of implants are also usually minor. The restorative phase is also usually a fast two visit procedure that required no anesthesia, or drilling. A single tooth replacement like yours can actually take only two visits, since I can actually take an impression for your final crown at time of impalnt surgery. In short, implant dentistry has changed my life and the lives of my referring doctors and their patients. Go and find a qualified prosthodontist (which I’m sure your Periodontist can recommend to you) and don’t hesistate to proceed with treament that has proven to be the most successful tooth replacement modality in the history of modern dentistry.
    By the way, have your general dentist call me, I’ll get him up to date.

  4. Ann,

    Your periodontist knows what he’s talking about. Get the tooth replaced, you won’t be sorry. Your periodontist probably also places implants. Have the restoration placed by either an experienced G.P. or a prosthodontist (either one should achieve an excellent result as long as the implant is placed in the right position which should be choreographed by the restorative dentist). The dangers of waiting too long are post extraction bone and tissue shrinkage which might then necessitate a bone graft in addition to the implant placement. I do agree, that the cost is the ONLY disadvantage.

  5. Dear Ann:
    Sometimes is painful to see cases like yours. Your only real problem,is your dentist, so put him aside allong with all your fears and go for an implant. Risk is minimal and as many of my patients say “Implants are my best friends”, it will probably be yours too.
    Good luck

  6. I must object. First, maligning a dentist as ‘ignorant’ is, well, ignorant. No where do I see information on what opposes #31; full denture? does #2 even exist? is it abutement for bridge (so no danger of drifting)? is patient 15 years old or 95? Is patient heavy smoker, diabetic, immuno-compromised? Way too little info is known.

    Also, many people live to ripe old age, healthy and happy without 1, 2 or any 2nd molars.

    Beware, the most ignorant people here are those speaking without sufficent data.

  7. Dear Ann: In January/06 I had a an implant procedure to replace a lost molar in the back of my left jaw. The biggest mistake of my life. I am in excellent health and was considered a prime candidate to have this surgery. My periodontist was very qualified and highly recommended. He has been doing implant surgery for 20 years. During surgery, some nerves were disturbed (I felt this during surgery). I have since had nerve sensations, pain and a metallic taste in my mouth. This procedure has greatly impacted my life in a negative way and I would not recommend it.

  8. Ann ,if you are really a patient, do not beleive in your doctor.If you are a dentist asking like a patient, beleive in all comments posted

  9. For any of the dentists here to insist that cost is the only con, I disagree.

    The degree of relevance for the factors mentioned in comment #2 may be different among patients, but not to bring it up to a patient who is considering a treatment option is not exactly informing the patient of the pos and cons.

    Since dentists on this post don’t know Ann’s exact clinical picture, how can anyone say that her dentist is ignorant? What if the opposing tooth/teeth has/have poor long term prognosis and her dentist believe that Ann’s remaining dentition provides enough masticating power and TMJ support?

    Comparing to the option of not restoring tooth #31 with an implant, placing an implant has the disadvantage of cost, surgery, time, and complications.

    How can any dentist be so definitive on a forum like this to give a definitive opinion without all the facts?

  10. Dear Ann: Don’t do it. There is a reason why most insurance companies don’t cover this procedure – many failures. Also, there could
    be permanent nerve damage and problems can erupt even years after placement. I have been in pain for l year and have been with no resolve. The implant was placed at an angle which hit the next door tooth which is perfectly fine. Now if I remove these implants my good tooth will be lost the second implant next to the failed one and my entire jaw may be break. Also, these surgeons, dentists, Perios and so on never tell you the risk that once you put it in, it is almost impossible to get someone willing to take it out. Good luck. Nerve pain is awful – it’s like a 24/7 toothache and we all know how horrendous that is. Good luck. I wish someone would have educated me prior to my implant nightmare! Jack Lanson.

  11. just had two implants, this is one week later, I feel great and lookig forward to the final attachment in August. There are payment plans and nothing looks bad than a bad mouth. This is your first line of contact with the public, a smile brings warm welcomes. You also will eat and sleep better knowing you did the right thing. Get a Good Specailist and live life.

  12. I have two friends with upper molar implants, the first a very healthy lady in her fifties has has major heart problems since the implant, the second a healthy placid gentleman in his 50ies has become very hipper and eritabile. I can’t help but believe these conditions in both are due to the implants.

  13. There are so many different opinions on this subject on so many different blogs/websites my head is spinning and my stomach is turning.

    My situation…my dentist wants to extract my second upper left molar, period. No mention of an implant (which I could not afford anyway). He claims it should not result in tooth shifting or affect my bite. Is this true or not? If it is not true I would rather just leave it there in it’s rotted/cracked condition until I can save up the money for an implant.

    If someone with knowledge of this subject could provide a response I would greatly appreciate it. Also, If I do have the tooth extracted now and can save the money for an implant to replace it 2 – 3 years down the road, would that even be possible.

    There seems to be a lot of hostility on this thread but, even so, I am looking for opinions anywhere I can get them.

    Again, can anyone provide a knowledgable, level headed response.

    Thank you.

  14. GREETINGS MIKE

    I AM A MAXILLO-FACIAL AND ORAL SURGEON WHO PERFORMS HUNDREDS OF IMPLANT PROCEDURES A YEAR FOR WELL OVER A DECADE. I PRACTICE IN AFRICA AND THUS HAVE ZERO MATERIAL INTEREST IN YOUR CASE.

    IT IS VERY UNLIKELY THAT LOSS OF THE SECOND UPPER MOLAR WILL MAKE A MAJOR DIFFERENCE TO YOUR BITE (ASSUMING THE REST YOUR DENTITION IS OKAY).YOU MAY EVENTUALLY FIND THE LOWER SECOND MOLAR OVER-ERUPTS UPWARDS AND THIS MAY BE LOST IN THE FUTURE. I SEE MANY CASES THAT CANNOT AFFORD AN IMPLANT. NO-ONE EVER BECAME MALNOURISHED FROM LOSS OF AN UPPER SECOND MOLAR.

    I DO HOWEVER KNOW THAT A CRACKED TOOTH OR A DECAYED NON IDEALLY ROOT TREATED ROOT IS LIKELY TO LEAD TO AN ABSCESS OR EVEN A CYSTIC PATHOLOGY UNLESS REMOVED.

    THE BONE QUALITY IN THE POSTERIOR UPPER JAW IS USUALLY POOR AND FOLLOWING TOOTH LOSS THERE WILL SOON BE LOSS OF AVAILABLE BONE IN WHICH TO PLACE AN IMPLANT. TO ADD INSULT THE MAXILLARY SINUS IS USUALLY VERY CLOSE TO THE TOOTH ROOTS AND FOLL TOOTH LOSS MAY ENCROACH INTO THE EXTRACTION SOCKET. IF POSSIBLE I TRY TO PLACE AN IMPLANT AT THE TIME OF EXTRACTION AS THIS WILL PRESERVE BONE QUANTITY. FAILURE TO DO SO LEADS TO BONE LOSS ELUDED TO ABOVE . SO IF YOU WAIT YOU MAY JUST BE SETTING YOURSELF UP FOR A SINUS-LIFT BONE GRAFT AS WELL. OBVIOUSLY THIS IMPLIES A MORE COMPLICATED AND MORE EXPENSIVE PROCEDURE.

    SO IN MY MOUTH I WOULD GET A GOOD OPINION FROM AN EXPERIENCED OPERATOR AND DEFINATELY REMOVE THE TOOTH(PRESUMED TO BE NON-RESTOREABLE).. IF THE IMMEDIATE IMPLANT IS NOT POSSIBLE I WOULD HAPPILY ACCEPT THE TOOTH LOSS AND HOPE TO SHED A FEW KILOS (WISH IT WAS THAT EASY).

    HOPE THAT HELPS SOME AND GOOD LUCK.

    PAUL

  15. OOPS!!!!!

    I MEANT THAT LOSS OF UPPER SECOND MOLAR IS NOT LIKELY TO MAKE A MAJOR DIFFERENCE TO YOUR BITE.

    SORRY FOR TYPE ERROR

    PAUL

  16. Paul,

    Thank you for your response. I am feeling more comfortable with the idea of an extraction now. The thought just took me by surprise initially.

    One thing, I suppose I am cursed with poor dental health but blessed with a high metabolism. I don’t have any pounds (kilos) to shed, so I guess that’s one thing I should be happy about.

  17. Dear Mike,
    I am an Oral & Maxillofacial surgeon in India, in exclusive Implant practice in the last 8 years. I endorse all that Paul has advised in lieu of the inevitable malady that you seem to be heading towards (extraction of your upper molar tooth). While it is true that bone loss occurring following the extraction of the tooth can leave behind an area which is depleted of bone and may make any future attempts to have an Implant rehabilitation rather less predictable in its outcome, it is also true that a simple procedure known as “Socket preservation”, (which aims at preserving bone in the region of the extraction and make it less amenable to loss in the consequent months following an extraction , than a conventional post-extraction socket / area would show) can and ought to be employed with bone preservation in mind.
    Several clinicians around the world , affirm the usefulness and benefits of this simple addition to a conventional extraction procedure.
    In the long run , you may even choose to have an Implant placed in the region (at an appropriate time, usually decided by the post-extraction void, the material used for the grafting as well as the rate at which healing has progressed in your case!)

  18. I would NOT do it. I have a friend who had implants done by the best doctor in town. They hit a nerve and she is in constant pain. No way to stop the pain unless they cut the nerve. But then her face will droop.

  19. 70% of function is 1st molar forward. I’ve placed lower 2nd molar implants but only when there is abundant bone and the inferior alveolar nerve is a mile away. Dr. Misch does not recommend lower 2nd molar replacements for the inexperienced for 2 reasons; likelihood of lingual perforation (more undercuts in this area) and likelihood of IA damage (the nerve is often higher than the mental foramen); combine the risk of these 2 possible complications with the benefit (70% of function is 1st molar forward) and there will be few patients who meet the criteria for lower 2nd molar implants. The vast majority will not “feel” the need for replacement of a 2nd molar. I’d recommend extracting the tooth and waiting to see if you feel the need for more function. I doubt you will.

    On the other hand, I almost always advise replacing teeth 1st molar forward.

  20. I just had my #13 tooth removed and I am considering either an implant or a permanent bridge. (The teeth on the each side of #13 are totally heathly) So far, I am leaning toward an implant, but some of these comments about nerve damage have me very worried. Is the risk of nerve damage more or less likely at the #13 location ?
    By the way I am 47, healthy, a non-smoker and have no other dental problems.

  21. Paula, rest assured you are very very unlikely to have nerve damage with an implant at #13. The areas you would seriously consider nerve damage is in the lower jaw towards the back. Talk to your doctor about the specific risks you may have for an implant at tooth #13. Typically, there is little to worry about aside from maybe the sinus cavity…but this is an easy workaround for most implant dentists. Either way, talk to your dentist and ask questions.

  22. Thanks for the feedback – I feel better. By the way, I did get a bone graft when the tooth was removed.

  23. I had my second upper molar from the back extracted due to a failed crown which resulted in an abscess and some bone loss. The tooth was extracted and a bone graft completed. Now it’s time to have a CT scan to determine whether the sinus duct has to be lifted. I’m wondering since I’m not too uncomfortable with the space whether I need to have a tooth implanted there at all. I have good teeth on either side of the space. Is there any downside to the gum or neighboring teeth in not replacing the tooth?

  24. Hi. I was just wondering what is the likelihood of having an uncomplicated dental implant placed in lower jaw albeit 2/3 years after extraction of previous tooth?

  25. Hi, I am going to have my lower left hand premolar just behind my bottom canine extracted. The extraction is being done by the Maxillo at a government hospital, but I don’t think they do implants. At the Maxillo they advised I get an implant to “fill” the space so that the neighbouring teeth don’t lean in.
    Is this the right thing to do?
    Also, should I ask them at the Maxillo to prepare my tooth in any way directly after the extraction?
    Finally, what should I ask for at the private dentist surgery in terms of removable etc implants that were discussed in earlier posts. (Money is a constraint for me, but if it has to be done, I will make a plan rather than choose the wrong option).

    Any advice or help from you guys would be greatly appreciated as I go to the Maxillo in a week. Thanks

  26. Mike, if you by any chance get this, I would like to know what your choice was. I am in a similar situation. Thanks!
    -Maury

  27. In May of 2011 my dentist suggested that I get a crown put on my upper #6 (second tooth from back top). So I did. He put on the temporary crown and two days later I got an infection. The permanent crown was put on hold as a result. The history of this tooth is: 8 years ago I had a root canal and I have had two rounds of orthodontia with a great deal of drawing teeth out to stabilize a good bite).

    Anyway…so I still have my temporary crown and since May and a week of antiotics I have been pain free. I have been to three dentists and specialists and they all recommend that I get my upper #6 removed (possible cracked root) and replaced with an implant. They all suspect, but can not confim, a cracked and damage root (the exrays are not confirming it).

    My concern is that I have been suffering on and off for 20 years with TMJ symptoms. I even had to have braces twice in my 20′s ad 30′s to correct my poor bite. Now with this new recommendation of an implant I am so afraid the drilling of the screw and the trauma to my upper jaw bone associated with the implant procedure will cause my TMJ symptoms to return. Must I get the implant or could I just go with having the tooth extracted and leave a space there?

  28. igot my lower jaw teeth extracted 31,41.please advice whichimplants to go for,dentsply,noble and alphabiodental imlpant? what the risk of implant hitting the nerve end in this region it has been 10 days i got teeth extracted

  29. Dentist is about to remove my first upper molar. I dont want an implant. I want to know If I get braces (to replace my 1st molar with the 2nd)Am I going to have problems after? or what can happen? I chew with my 1st molar. And I really dont want a bridge or implant (think both are agressive solutions)
    Thanks

  30. I beat you all:
    69 years, smoker, diabetic [diagnosed 3 years ago]. Yay. And…
    Lots of cavities when 6-12. Not great hygiene as kid.
    2nd bicuspids pulled for braces in college. Gaps closed.
    Lovely, perfect teeth for years.
    Then gumline starts to recedes, then small caries, couple crowns in 40-50′s. Cut to:
    2 teeth pulled 2 months ago [both 2nd molars, left side]. Awaiting implants. BUT I
    really wonder at my age if they are really necessary. I don’t want to/nor do I think I will live ‘forever,’ thus are they really necessary?
    2 OPPOSING MOLARS ON SAME SIDE OF MOUTH–GONE. Don’t know the terminology. I have done/do a lot of grinding, thus the bite compromise and cracks in teeth.
    AND, YES, I DO TAKE ALL INTO CONSIDERATION: age, $$$, diabetes (when the disintegration began), et al.
    If you are a dentist, what would you tell your wife to do at 69 years old?

  31. Hello!

    So I’ve two teeth extracted, the very back molars: One on the upper right in the back, and one on the bottom left in the back. Surprisngly, the removal of these two have caused the two wisdom teeth there to fully erupt (one is actually fully erupted, the other used to be very partial, but you could see the whole head (or crown, for my lack of dentistry terminology, haha). Anyway, my dentist keeps persisting that I get dental implants there, but the reason he keeps giving is because I’m a young woman. So I assume he’s just talking about the aesthetic benefit for me. But really, I would rather do without the implants if that is the case. It was only until he mentioned implants again that he warned me of teeth shifting and problems chewing. I have no problems chewing as it is, except to avoid getting food under the gum flaps of my erupting wisdom teeth, so do I REALLY need implants? Especially since there is no opposing to to the extraction sites? Is the chances of those heath risks in my predicament low?

    Please help!

    • Ah! Spelling mistakes galore.

      What I meant in my original post is that there are no opposing teeth to the extraction sites (It’s not like “tooth, gap, then tooth again”).

      I would very much like to hear that it’s mostly for aesthetic value in my case, in that way I can feel comfortable enough to dismiss the idea of implants. It’s not like it affects my smile, you know? :) But let me know your thoughts on it, please.

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