Molar extraction - implant, denture, or leave gap?

[AngelCatMei]

Hi all,

I've scheduled an appointment with my dentist for CT Scan and guided implant planning in a few weeks time and in about a month or so, I'll be able to get the implant in.

I've been missing my lower right first molar since about 2 years plus ago? I should be getting an implant in sooner but I pull out of plan despite already getting an consult and CT scan done 1 year plus ago.

I went for my regular cleaning last month and took a full mouth xray as a routine and my dentist urge me to get an implant soon as my lower left second molar is slowly shifting forward to the empty space.

I've my own fear about implant as I saw some blog about how some people gotten a bone infection after getting the implant and they got to remove the implant. I'm afraid that my body will reject the implant as I'm quite sensitive to it. I think that's the reason why my root canal failed (I've another root canal in my upper right first molar now and it just never felt right since the treatment).

I texted another clinic asking if they do flexible denture for just one tooth. They said they it's doable but they don't recommend it as mucb as implant, especially for cases where patient is already losing lots of bone. My current dentist don't wish to do denture for me despite my asking multiple time. The reason is because I'm still young so they're constantly pushing for implant. Tbh I couldn't even afford an implant, hence, I left that gap for years till now. I even got a loan from the bank for this implant, so I don't wish for it to fail

I looked at my xray and saw that there's like shadow on the jawbone at where my missing tooth was once at. Will any of you be able to advise me what's the shadow at the x-ray means?

Thank you

 

[Gordon]

I would strongly advise against getting a denture for 1 lower molar, it will be very difficult to wear and will do more harm than good. (I would probably not bother getting an implant either, being one molar short is not a big deal).
The shadow area is where the bone still hasn't fully filled in to replace the tooth yet, it takes a long time to fully regrow.

 

[MountainMama]

I also have a missing molar, although mine is the upper 2nd molar. I never had it replaced.

 

[NervousUSA]

This is really interesting, AngelCatMei, is your dentist telling you it is not an option to just not replace the tooth? I may be in a similar situation to you, I am right now gearing up for an implant that I didn't want, after being told by two dentists that it would be disasterous not to replace my missing molar, and pretty much not an option, my other teeth would tilt, super-erupt, be lost, etc, and that I must have an implant, bridge, or partial denture/flipper. I wanted to just not replace. MountainMama does your dentist pressure you to replace your missing molar? I am so confused seeing Gordon, a dentist, say it is ok not to replace a missing molar, and ok not to have an implant or denture after what I have been hearing. I wonder if this is differences between the USA, UK, and Singapore or what is going on here?

 

[MountainMama]

This is really interesting, AngelCatMei, is your dentist telling you it is not an option to just not replace the tooth? I may be in a similar situation to you, I am right now gearing up for an implant that I didn't want, after being told by two dentists that it would be disasterous not to replace my missing molar, and pretty much not an option, my other teeth would tilt, super-erupt, be lost, etc, and that I must have an implant, bridge, or partial denture/flipper. I wanted to just not replace. MountainMama does your dentist pressure you to replace your missing molar? I am so confused seeing Gordon, a dentist, say it is ok not to replace a missing molar, and ok not to have an implant or denture after what I have been hearing. I wonder if this is differences between the USA, UK, and Singapore or what is going on here?

My oral surgeon told me that it depends on the tooth and the person’s preference. He said he did not recommend replacing an upper second molar, as the lower opposing molar is less likely to super-erupt. He also said that first molars are the most used molars as far as chewing forces and he recommended replacing them, but he didn’t push implants. He said a lot of times a bridge would work, but that implants are more successful long term. He did say that with first molars being gone, the second molars are more likely to shift forward. I think each individual person probably has different situations as well.

 

[AngelCatMei]

@NervousUSA

Hi, my dentist did told me it's not an option to replace the lower first left molar with a partial denture and provided that I'm just 26 years old, so she says implant is the only way to go. She says that the lower second molar is starting to tlit forward, so it's better if I can get the implant soon.

I went to enquire about another clinic to see if it is possible for one tooth flexible denture. The clinic that I enquired mentioned that it's doable but not as recommended as implant, and especially for cases whereby the patient is already losing lots of bone.

I'm very confuse too like, it's not that I didn't want implant. I'm just really afraid of the complications and what if my body rejects the implant? There's lots of what if.

When is your surgery? Mine should be around mid September.

 

[NervousUSA]

@AngelCatMei I have had that experience with different dentists saying different things too, it's so stressful and confusing. BTW my missing tooth is front lower left molar like yours. The first dentist I saw about this in my early 30s wanted me to have a bridge, partial denture, or implant, and thought all were good options, but implant was best. This was basically the opinion of my second dentist too, though she was more against the denture and very agressive about an implant. Neither was very willing to remove my tooth and not replace it. My current (3rd) dentist said that the partial denture would be bad because it would be so small I might aspirate it and I just wouldn't wear it, and implant was what he would do if he were me (I am around 40 now). We didn't even discuss bridges, that is the treatment that has always seemed the worst option to me, because of grinding healthy teeth down, or removal without replacement. I've also been very confused about why it is not ok for me not to replace my tooth, but it seems to be fine for lots of people

I am really scared of things going wrong too, like infection, rejection, allergies, nerve damage, etc. I am also dealing with a drug and anesthesia phobia with worries about that going wrong, having to talk about drugs, being offered drugs, etc. I have been trying to comfort myself by saying I must go on statistics, not my emotions, and success of dental implants is 95% but I still am scared, it has been a cold comfort. One thing that has made me feel better is that my current dentist showed me a broken implant he had removed from someone, I felt a little better thinking if something goes wrong at least it can be removed and maybe I could at least get back where I was, where I am now.

At my planning appointment the dentist had me in a treatment room and I heard him whispering outside the door with his assistant by the cat scanner/cone beam machine and I just heard the words "implant" and "there's so little bone" and I have been haunted by that, I was afraid to ask if they were talking about me...

My surgery is late August. I hope everything goes really well for you for yours!!! I think your young age is probably an advantage for you with this treatment with things like healing and resisting infection.

 

[AngelCatMei]

@NervousUSA hope that your surgery goes well! Anyway, just an update that I've decided to get a flexible single tooth denture instead of implant I'm really nervous about complications and I think if I'm gonna lose more teeth in the future due to whatever causes, I don't think I'll be able to afford implant for every single tooth. Hence, I decided to get a denture instead. I already went for the denture wax try in and will be getting the denture next week or so. It's really tiny and the new dentist I went to told me that it'll not help much with chewing but it does help to prevent the tooth behind from shifting more. She told me to eat slowly during the initial stage if I'm afraid of it slipping out and swallowing it. I bought some denture adhesive as well for in case.

 

[Gordon]

Please please please make absolutely certain that you remove this denture when you go to bed at night, every time. They don't show up on x-rays and if you manage to inhale it the consequences are severe.

 

[NervousUSA]

@AngelCatMei Thanks! So far so good. The surgery itself was painless and not too bad, I needed 3 doses tylenol yesterday, and am not in pain today, and I don't think I will get an infection since I am on a huge quantity of antibiotics for the next 10 days. If you are still curious at all about implants, I can keep you updated if I have any complications. I hope the partial denture option goes well for you, I had seriously considered it myself until I learned it could damage or wear your other teeth, and I came to believe it was more likely to damage other teeth than the implant, and about the aspiration issue (my dentist told me it would be okay to swallow it but deadly to inhale/aspirate it), and I had also seriously considered no replacement (many people I know including both my parents are missing molars and have no side effects they have an issue with). The financial issue with impants is really serious too. I hope all goes great for you though, and please update what the partial denture is like once you have, if you feel like doing that.

 

[AngelCatMei]

@NervousUSA

Hi, I just gotten my one tooth partial denture and I hate it :/ it's comfortable but idk, it just doesn't feel safe to have something in my mouth and I'm constantly worrying that I'll swallow it when I'm eating. I took it out when I'm eating and that kinda of defeat the purposes of it.

 

[NervousUSA]

@AngelCatMei Thanks for the update. I'm sorry to hear that! My dentist did say that it would be unsafe when it comes to aspiration/inhaling but he wasn't so worried about swallowing it. He also said I wouldn't want to wear it, maybe he said that becuase a lot of people don't find them comfortable, I don't know. Please be careful about that inhaling. Maybe you will get more used to it, hopefully?

 

[TickingClock]

@AngelCatMei

I'm in similar situation too, I wonder how does a single tooth flexible denture feel? How inconvenient it is?

@Gordon

You mentioned that you are against denture for 1 lower molar, what if it's upper incisor? I'm going to extract my upper incisor, and I know that there are 3 options, implant, bridge and flexible denture. For my case, implant may fail & I don't want to do bridge (as it hurts my other teeth), so flexible denture become my final option if implant fails

 

[Gordon]

Upper incisor is different, a denture is a reasonable option. Look at a Maryland bridge too, doesn't damage the supporting teeth.

 

[AngelCatMei]

@TickingClock

It's really tiny and when I tried to chew with it, it doesn't move that much but you will certainly feel uncomfortable as it's like a foreign object in your mouth. And, I couldn't get over the fear of swallowing it as it's really tiny. Think its a nesbit.

 

[AngelCatMei]

@NervousUSA Hi! How's your implant doing? I'm finally going for my guided dental implant planning two weeks from now and surgery estimated on mid Feb. Finally after 4 years of missing this tooth.

Previously when I was scheduled for the surgery, I cancelled it after watching a video of a lady getting major infections after getting her implant overseas. I cancelled it out of fear and went to another clinic to made a nesbit instead as per my previous update. In the end, just after a day of wearing the nesbit, I couldn't adapt to it and didn't wear it anymore. It's too small and I'm afraid of swallowing or inhaling it.

Now, I'm afraid once again as I came across an article of major artery been drilled on by accident during surgery and cause the floor of the mouth to swell up due to hemorrhage and it could block the airway due to the swelling.

I'm really worried of any complications like excessive bleeding, damaged nerves, infection or etc.

But I'm just gonna go ahead with it. Hopefully everything will be fine.

 

[NervousUSA]

@AngelCatMei My implant seems to be doing well. Since we last talked I had a small surgery to have it exposed and have the healing abutment put on, I went to the crown making place to have the color of my teeth matched last week, and supposed to have the crown put on next week. So far, so good. I think you are doing the right thing going forward, because in the end, I think the small partial denture would be dangerous. I was very afraid of complications too, but what I ended up deciding is every path had complications, including the options of doing nothing, having a bridge, using orthodontics to close the gap, and the partial denture, and I looked at the statistics for dental implant failure. It is a very low failure rate, like 5% and failure almost always has patient factors involved like smoking, not following the dentists instructions, diabetes, and poor oral hygiene. I did a bit of online research and this is what came up. I still felt scared but decided I must guide myself with logic not emotion, even if statistics are a cold comfort. In the end I prayed to God to help the dentist do a good job and for me to be OK and went forward with it. This person overseas you saw on the video would likely have been fine if they didn't go overseas. If you have a cone beam x-ray the point of that is to give the best chance possible to avoid structures like nerves and arterys. You shouldn't get an implant from a place that doesn't do a cone beam x-ray, is what I am told. I think the guided implant planning will probably involve one. Best of luck and please keep me posted!

 

[NervousUSA]

@AngelCatMei
Hey I am sorry to have to say something negative about dental implants but I thought I should pass this along to you. Maybe you already know this. There is a chance they are hard to clean or will require special equipment to clean, like waterpiks or special brushes. I asked at my first consultation about them if they could be cleaned normally and was told yes, but now I find this is probably not going to be the case for me so I feel a bit betrayed. I don't know if this is different case by case or not. But I suggest you ask your dentist about it in your case.

 

[AngelCatMei]

@NervousUSA hey! Thanks for letting me know about this. I wasn't aware of it as I thought that normal cleaning will be sufficient. But I do have a waterpik. Will definitely check with my dentist about it on next Wednesday. I've been wondering am I allowed to wear my retainer after the surgery? Will I be able to brush my teeth (except to avoid the surgical area) after the surgery?

My main concern is actually the bleeding. I'm really afraid of blood. I'm afraid that the blood won't clot.

Anyway, congratulations for having the crown put on! I'm so happy for you that you've came such a long way since we first spoken about it you're really brave and I'm really really proud of you. Do invest in a waterpik as it really change my world. I've really bad gums in the past prior to braces. My gum started became healtier after using waterpik before flossing and brushing.

 

[NervousUSA]

@AngelCatMei You might want to ask your dentist's assistant or hygienist, it was my dentist who told me they could be cleaned normally, his assistant and hygienist said different. The assistant showed me a water pik head or tip that she said the waterpik company recommended for implants, I looked it up online it was the "gum pocket" head. When it comes to bleeding, there are two different ways the surgery can go, either you can end up with a healing abutment (cap), or you can have two stages, starting out with the dental implant totally under your gums, and then a second surgery to expose the implant and put on the healing abutment. You don't have that need to form a blood clot after the surgery that a person has when having a tooth extracted, because you end up with a stitched up incision, so it is closed. It's the same with the healing abutments, those things cover part of the wound and then the rest is stitched up. It is not like there is a socket that has to form a clot to stop bleeding. I brushed my teeth after the surgery just avoided that area, like stopped brushing one tooth away from it from either side. I don't wear a retainer so I don't know about that, but I imagine I would have needed no more than a weeks break from wearing the retainer. The implant surgery was extremely mild to recover from compared to tooth extraction. You might want to ask your dentist how long it will be, it was suprisingly long for me, over two hours.

Thanks for your positive comments about water piks. I am going to listen to you and use one. I got horrible gum recession from braces that has kept getting worse with age so maybe it will help me too. The truth is, I think once you lose a tooth, you won't really be cleaning normally again whatever you do, and this is probably going to be less annoying than cleaning a partial denture or bridge.

Thanks so much for saying those nice things to me! You don't know how much it means to me to hear someone say that! I will say the exact same thing to you, you have come so far, and I am very impressed by you and proud of you, and you are showing courage! Best of luck on next Wednesday! Please keep me posted how it goes and let me know if I can give you any information from my experience that may be of use to you at all.