To Implant Or Not To Implant...

...that is the question. Whether 'tis nobler in the mouth to suffer the slings and arrows of outrageous surgery or to take drugs against a tooth of trouble, and by opposing end it.

Argh. Molar split in two. Done. Can just have it removed as it's the last one in back on the bottom, else have an implant as I'm apparently a great candidate for it. Would removal make it odd to chew with no molar back there (there's one above)? Does the cost (a few thousand) and time (months?) and pain (thus dentistry makes cowards of us all) of an implant more than offset the (long-term?) benefit? Anyone have any perspective?

Get the implant my friend, you need to chew./

When a tooth is removed your other teeth move to accommodate the space and you can run into some bad situations then. Get the implant. It's worth it - dental health makes for a much happier life.

As an FYI, I found the procedures involved to be painless (in the physical sense of the word) and the appointments (3?) to be relatively brief (about an hour each).

Implants are certainly costly. I pretty much had to have it, so chose to consider myself lucky to be able to pay for it.

I have 4 implants - lower back teeth on both sides. While waiting for the implant area to heal before the final crowns could be applied, I did see some shifting of my lower teeth. It stopped once the final restoration was in place, but I'm sure it would have continued if I hadn't chosen to do the implants. I was also told that the top teeth could go out of alignment or even drop down a bit without the lower teeth in place to oppose them.

The pain was financial, not physical. Once you are numb, you don't feel the dentist drilling into the bone to position the implant - you feel vibrations, but no pain. Afterwards, motrin was fine to keep me comfortable for a few days when the area was tender.

My dentist didn't do "same-day" implants. They first extracted the remains of the tooth/teeth that had broken and gave the bone some time to heal. Then, the implants were placed and the gum flaps sewn over them and this healed for about 4 months. Then, they opened the gumflap to expose the implant sockets and put the implant screws into them. At this visit, impressions for the final bridge were taken and I went home with a temporary bridge in place. The next visit put it permanently in place.

Two dentists were involved in this whole thing - the first did the extraction and placement of the implants into the jaw and the second (my regular dentist) did the cosmetic restoration work. They coordinated very closely, though.

It was expensive and insurance only covered the extraction. Even though I had no choice but to do the implants (or to do nothing and let my teeth shift every which way), it was considered "cosmetic" work. The insurance company didn't care that the back tooth had broken and there was no way to do a standard crown or bridge. That was annoying.

eta: While the area was healing around the implants, I didn't find it odd or uncomfortable to chew my food. I don't eat beef or any red meat, so I can't speak to that, but I had no problems with chicken, fish, pasta, veggies, salads, bread or anything like that. Any I remember my grandfather had ALL of his remaining teeth extracted when he was 75 and he refused to wear dentures (this was back in the 1950s, so implants weren't even a possibility). His gums healed and he was able to eat anything and everything for the next 20 years of his life - steak was one of his favorite meals!

I had to have a bottom next-to-the-last molar removed. I couldn't really afford an implant. I talked to the dentist about teeth shifting, but we decided at my age (57 at the time) it was not that big an issue. It would have been a different story if I were a lot younger.

The gap doesn't show at all. If it did show, I would have gotten the implant. Chewing was weird for the first several weeks, but now I don't notice it, or maybe I shift food around subconsciously to compensate.

Is there a waiting period between the extraction of the current tooth and the first step of the implant? Maybe you could try going without it for a few weeks and see how it feels?

Thanks all. To be honest, it's the decision that troubles me. If I was told to have the implant I would-- no questions asked-- and move on. But when given an option like this I tend to overthink it.

Insurance will cover 80% of the extraction and 50% of the final crown (whatever that means, but that's it. No idea how much the difference out of pocket is, and while it won't have an effect on the decision, I'm curious.

Dude. Get the implant. You're too young to be debating this...

Your dentist can give you a cost estimate.

It is clear from x-rays that mysinuses are very close to the surface in that area, meaning an additional round of surgery to reposition them if I decide to go ahead with an implant. That might be something to ask about. I am not sure I am willing to risk setting off a different problem.

Your dentist should also be willing to work out a payment scheme if it's too much to pay it all up front.

Ill just pay it up front, but just curious more than anything.

j_r said:
Your dentist can give you a cost estimate.
It is clear from x-rays that mysinuses are very close to the surface in that area, meaning an additional round of surgery to reposition them if I decide to go ahead with an implant. That might be something to ask about. I am not sure I am willing to risk setting off a different problem.

Repositioning sinuses? I had no idea such a thing was possible.

I honestly can't remember why this is - having to do with either tooth removal for braces or a sole wisdom tooth that came down - but I have an extra top tooth in the back of my mouth on one side that is not matched on the bottom. I have no trouble at all with chewing. (I do drool sometimes....just kidding!) I would never even notice it except that it is sometimes remarked on at the dentist.

Edited to add: There, I just saved you thousands of dollars.

LOL, thanks!

In the past few years I had to have both lower molars on the right removed and the last one on the left side. I also had to have bone put in where they took out the tooth. At this point I have only had one implant done- the second to last molar on the right side. I'm in my early 50's and am going to hedge my bets that my teeth aren't going to shift. The implant crown was pretty darn expensive too. Not sure if I can swing getting the last molars done on either side.

Good luck!

My husband had the bone grafting done many months ago and had the screw placed on Saturday. Neither were painful at all. Quick and easy appointments. Insurance covered all of the extraction work and will cover most of the cost of the crown part (which is roughly 1/3 of the totalcost of the implant).

Rule of thumb is that if it is a back tooth, you can do without it and it will have limited impact on tooth shifting because it is the last tooth anyway.but if it is space between two molars, they will shift and tilt to fill in the space so you are better off having it done

I need a root canal or implant. I guess that means I'm lucky I have a choice. I'm told the root canal may not last so an implant would be a more worthwhile investment. But I ain't got the cash. Not sure what to do.

You might also want to ask if the work may affect your migraines ( vibrations and shifting from the drilling etc, plus any subsequent adjustments in the bone and jaw hinge, trigemminal [sp] nerve or muscles).

Good point, though if it does that may not be a bad thing.

Unless the change doesn't work well... Which helps with diagnosis but not much else. Anyway, hope it all works out!!

Another vote for the implant. Another lower rear molar. And yes, the $$ was painful. Glad I did it though - there was definitely some shifting of teeth between the time of the extraction and the time that the crown was finally in place. And once the crown was installed, I spent the first several weeks biting into the inside of my mouth when eating - evidence that my chewing patterns had changed with that tooth missing.

Implants are wonderful, no doubt about it. Implants are VERY costly, no doubt about it. given the choice of whether or not one should save a tooth or have a tooth removed in favor of a titanium screw sticking out of ones jaw, should be thoroughly reviewed.

If the bone support is compromised (i.e. if it is periodontally involved), around the tooth in question, then the patient would be well advised to CONSIDER an extraction followed by an implant. There ARE other options, however. A patient could decide to go with the "tried and true traditional bridg"e, when the dentist will prepare and recontour the teeth on either side of the edentulous space for full coverage and then take impressions to have the lab fabricate a 3 unit bridge (or 4 units, or however many teeth are involved!). Most dental insurances DO cover fixed bridgework, or certainly a good portion of it.

if on the other hand, a tooth could have alot of caries and may in fact, be quite broken down - however, if the bone support surrounding this tooth is INTACT, then the patient SHOULD opt for a "cap" (a crown....perhaps even a post and crown, to help rebuild the core). this takes only 1 -2 weeks to do.....on the other hand, once the implants must be placed, AFTER the socket is "healed" (which takes a couple of months) and then once the implant IS placed it needs to osseo-integrate within the bone and that takes anywhere from 3-6 months, and then the general dentist can go ahead with the crown.

someone mentioned the fact that they don't have enough "vertical bone" to support an implant in the upper arch, due to the sinus's which may be coming down very low....in those cases a procedure known as a "sinus lift" is done, to add more vertical bone which will add the necessary depth in which to insert a dental implant. While it "sounds" like a very complicated procedure, an experienced oral surgeon does these procedures reasonably frequently.

mind you, dental implants are NOT fool-proof. If not done properly, they CAN fail and they CAN be poorly placed (angulation wise) and on rare occasions, they could perforate a landmark that shouldnt be, and they could be placed too close to the inferior alveolar nerve, causing a degree of parasthesia to the lip. obviously operator "experience rules" here

implants ARE wonderful. having said that, each time one breaks a finger, most people try to repair the finger and save it....they dont jump to an artificial prosthesis to replace the injured, or maybe even deformed finger.....same thing with a tooth; if you have a bad tooth WHICH COULD BE REASONABLY SAVED, then it should be saved! - - A root canal, a post, a crown is a whole lot more affordable, AND NICER, than a metal post protruding out of your jaw (like that evil criminal "jaws" in the james bond movie!)....however, if the tooth IS in bad shape, then by all means, one should EMBRACE THESE IMPLANTS or give serious consideration to having a fixed bridge (or a cantilever bridge) placed!

be aware, that if one puts several implants in their mouth, the cost could EASILY equal the price of a nice new car! And most people have priorities in life which need to be studied....kids, college tuitions, mortgages, retirement funding, other bills, etc

as far as your teeth shifting each time a tooth is lost, that is TRUE! The opposing tooth will super-erupt downward (or upward) and the adjacent teeth will tip into the missing space, if left edentulous for long periods of time. Temporaries can be made (and that TOO adds to the cost - - particularly if the temps are laboratory processed temps)

so no one case can answer all individual cases....as far as dental anatomy is concerned (both maxilla and mandibular considerations), patient finances, the operator's experience and skill, the time involved, dental insurance

oh...one more thing which i read from above....the posterior teeth (the "back molars") are the teeth which are functionally the grinding teeth and they support our vertical bite (ever see the collapsed face of a person without posterior teeth?). When a person bites a piece of food, they automatically move the food to the rear of the mouth, where our teeth can grind and chew it. We NEVER grind food with our front teeth (like a bunny rabbit!)!...so yes, while people cannot "see the missing space" when a back tooth is lost, these teeth are actually more functionally important than the anterior (front) teeth....however, obviously our anterior teeth have a HUGE cosmetic impact and if one is missing an anterior tooth, there is all sorts of embarrassment involved and the psychological impact on our personal vanity is intense. so one should NOT dismiss a missing back tooth simply on the basis that "the space cannot be seen"!....so you see, ALL OUR TEETH ARE IMPORTANT !

I don't think the choice here is between saving a tooth vs getting an implant. Maybe I read it wrong. In my husband's case, the tooth was gone. It was severely damaged and the root had become badly infected. The toothy removal was the only option.after that, the options became 1) putting a bridge- which, as I understand, basically ruins the two teeth on either side 2) utting an implant in or 3) just leaving a missing toot

Just wanted to add that, in my case(s), the very back lower molar was affected. In each case, it had been the back tooth of a 3-unit bridge spanning a missing middle tooth. So, when the back molar broke, it required 2 implants on each side because (I was told) you can't do a bridge that connects a natural tooth to an implant. To keep the teeth in alignment, the missing tooth that had been replaced by the bridge had to be replaced by an implant, so two 3-unit bridges became 4 implants. The front tooth in each bridge was kept as it had been, with the bridge being cut off behind that tooth.

The most difficult part of the whole process was having the impressions taken for the final restorations - they were so far back in my mouth and they put marker screws into the implants for the impression process - it was physically difficult to get my mouth open far enough to get the impression material out once it had hardened.

Not trying to overload you with negatives, just telling you things I wish I'd been forewarned about.

Thanks, @MapleBri, for identifying why dentistry terrifies me.

If you need to ask the question (to implant or not to implant), I think you have answered the question (no). I did an implant. I thought the procedure was tolerable (though pretty uncomfortable) and expensive (not covered). But for me, it was a no brainer -- I was already down a few adult teeth (they never grew in) and I thought any more loss was too big a hit. Otherwise I would have spent my time and money much differently!

ctrzaska said:

Would removal make it odd to chew with no molar back there (there's one above)?

Ay, there's the rub.

Get the implant. Request pre-approval from your insurance company if needed for coverage. Your regular dentist may refer you to a specialist to do this procedure. Either way, you should be given a firm quote as to cost and time/number of visits required to complete the procedure. X-rays will be taken to identify any physical conditions in your mouth/jaw that could impact on the procedure. As they say in the commercials: tell the person performing the procedure of any medical conditions and medications you are taking that could influence the decision to go ahead with the procedure or the manner in which the procedure will be performed. Feel better and good luck.

DaveSchmidt said:

ctrzaska said:

Would removal make it odd to chew with no molar back there (there's one above)?

Ay, there's the rub.

Well done, sir.