Dentists please help - molar predicament question

[thetoothisoutthere]

Please help with some impartial and unbiased advice. My upper-left molar was re-root-filled about 6 months ago and was done carefully as I have a fracture down the centre of the tooth which had been caused by a previous dentist. I was told to monitor it for a month to see how it took and it was fine - until now.

All of a sudden the other day it felt uncomfortable when biting, to the point where I needed to eat on the other side of my mouth. I went to my dentist and had 2 x-rays which weren't really conclusive, he showed some slight greyness and said it could be an infection or something else. He gave me antibiotics (amoxicillin) to take for a week to see how they did, and he said best-case scenario was this may give me another six months to play with, but that eventually the tooth would need to come out. He said even if the tooth resumed normality I could still make a 45 minute appointment for an extraction in the near future.

He said that if it comes out I basically have two options - he said he wouldn't want me to have a bridge because they ruin perfectly good teeth either side, so he said I should either leave a gap or have an implant. I asked if long-term the implant was the sensible solution and he said realistically, yes, because the teeth where the gap would be would move in over time and the bone would be weak. Also the other side of my mouth would be doing twice the work and so wear out more quickly.

So...I am nearly through my tablets and my tooth is much better, although not perfect. And so I don't know what to do. I wanted to get through Xmas without having a major tooth missing but I've been advised this isn't wise. If I do have it out, should I leave a gap or have the implant? Are the repercussions of leaving a gap major, or would having the implant be worse? I've read that it's possible to have issues when having different metals in your mouth, eg titanium from an implant and other metals in a filling, is that true? I've also read that if you put an implant where you had an infected root-filled tooth it is more likely to fail, is that true?

Please please please please help, I am so confused.

 

[Gordon]

I'll leave the specifics of implants to comfortdentist, since he's the implant expert, but there is no problem with dissimilar metals when it comes to implants, the implant is covered by the porcelain/gold superstructure and doesn't come anywhere near the other teeth.

A lot of people manage perfectly well with one missing molar, so I wouldn't be too concerned about the effects of the missing tooth from the sake of the health of the rest of your mouth.

 

[comfortdentist]

As to implants and previous infected tooth. In order to minimize complications I would advise the following.
1. Extract the tooth and thoroughly clean the socket.
2. Allow tissue to grow over for the next 6 weeks (more like 8 if you are a smoker)
3. Open the extraction site and decorticate the socket.(That means drill into the bone the held the tooth)
place your bone graft material of choice most are okay as long as it isn't demineralized bone. Suture the site
suture the site closed.
4. After waiting a few months go back in and place the implant.
By doing the above the bone has cleared of all of the infection Prior to implant placement. IF the site is not infected I would bone graft at the time of extraction whenever possible.

As with any surgical procedure there might be variation on certain cases just make sure that you have a reason for what you are doing.