lower left second molar implant?

[olanda]

hi

due to dental negligence i need the lower left second molar extracted. i've never had a wisdom tooth next to it. my previous dentist has paid me more than enough compensation for an implant and it has been definitively decided by my endodontist that the re-treated root canal has failed.

i'd like to have an implant put in (i'm only 31 and very conscious of my health/looks) and have recently had consultations with two highly recommended oral surgeons and one prosthodontist (all of whom regularly place implants).

however, now i'm really confused!! one oral surgeon said i should definitely have an implant placed as if i don't the upper tooth could grow down over the years necessitating its extraction also. the prosthodontist said i *could* have the implant placed but i really didn't need it and if it was his second molar he probably wouldn't do it. the other oral surgeon said that of the thousands of implants he's placed he's only ever done around 20-30 second molars and it's much healthier to leave the space as no-one will ever see it and you don't need that tooth for chewing (i can give the names of these dentists if it would make a difference to anyone).

i'm at such a loss for what to do - of course i want that tooth still there but i also want to do what will be in the best interests of my health. these conflicting opinions make it really difficult to know what's 'right'.

so, my questions are:

1. what would anyone else do in this situation? implant or leave the space?

2. what are the 'risks' of having an implant (apart from nerve damage, which i think would be very unlikely with a skilled surgeon)? why would it be more healthy to not have the implant?

i'd really appreciate having a few different opinions regarding the first question - whether or not you'd have the implant there - to help me make my choice.

thanks very much

 

[DrMike]

1. what would anyone else do in this situation? implant or leave the space?
Personally speaking- I'd probably have the implant.

2. what are the 'risks' of having an implant (apart from nerve damage, which i think would be very unlikely with a skilled surgeon)? why would it be more healthy to not have the implant?
Your implantologist will chat you through all the risks in your case- but the main one is probably the very low risk of nerve damage.

I guess it would be more healthy in that there will be less dentistry to ultimately fail in the future! It is true however that the opposing tooth may overerupt in time (we're talking several years)- meaning that it is possible in the distant future it may need to be removed also.
Us dentists often talk about the shortend dental arch- which basically means having teeth up to the 2nd premolars only (ie having no back teeth). It is generally accepted that this gives you enough function and aesthetics without the need for dentures/implants etc.
So really there is no right or wrong answer here- only what you feel yourself. This isn't just about you 'coping' with one tooth less than you had- I think it is much deeper than that and my gut feeling is that if you have had compensation that would cover the costs- then personally I'd go for it. Without seeing you for a consultation in person I can't give you a clinical opinion- only my personal thoughts for what they're worth!

Let us know how you get on whatever you decide!

Regards
Dr Mike