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Old 04-12-2007, 09:05 PM   #1
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walkunafraid HB User
Tooth extraction and implant -- immediate or over time? Precautions?

Hi all,

I had a root canal on my bottom left molar a few years ago. Last week, I went in for a cleaning and the hygenist found that the crown was loose. After some further investigation, it was found that bacteria had gotten under the crown and into the tooth, and had caused an infection. As a result, it was determined that I need to have the tooth extracted.

The dentist strongly suggested that I get an implant; she said that if I don't, my teeth will shift over time, the tooth above the molar will lose its use, and I would basically be riddled with dental problems over time. I'm only 28, so I figure I should take her advice rather than risk a lifetime of stressful tooth problems.

Anyhow, she suggested I get the tooth extracted and the implant put in all at the same time. From what I have read here, people most commonly seem to have an implant put it a while after the tooth has been extracted. Is immediate implantation after an extraction a good idea? What are the advantages/disadvantages of doing so?

Also, I am pretty nervous about the implant because a colleague of mine had the same procedure last year and it did not go well. Evidently a nerve in the jaw was struck during the surgery, and she has suffered almost constant pain since then. I can't even imagine going through that, so needless to say I am very worried about getting the implant. Is striking a nerve a common thing during this type of surgery? Are there any precautions I can take to make sure this doesn't happen? Is there any other advice you can give me?

Sorry for my first post being so long...thanks in advance to anyone who can help!

 
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Old 04-13-2007, 06:02 AM   #2
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ms58 HB User
Re: Tooth extraction and implant -- immediate or over time? Precautions?

I think you would be better off going to an implant specialist rather than getting it done by a general dentist. The specialist may have a different opinion about doing both at the same time.

When I had my implant done the specialist, a Maxillofacial Surgery dentist, pulled the tooth and wanted to wait a few months to be certain the jaw bone healed properly before doing the implant. He did a whole mouth xray before and after to check. Waiting a little longer than less is better. All healed well and after a few months he then did the implant of the post. Again waiting a few months for healing before putting the final "tooth" in, my general dentist did the final tooth placement.

All at once was not his choice for the above reasons. He felt when the tooth was first pulled the jaw was not ready for the post implant.

I do highly recommend the implant, just be sure someone very experienced does it, as you know, problems can occur if done improperly.

 
Old 04-13-2007, 09:32 PM   #3
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walkunafraid HB User
Re: Tooth extraction and implant -- immediate or over time? Precautions?

Thank you for the great advice. I have an appointment with an Implant Specialist next week. I really like my dentist and feel slightly uneasy going to a new person to work on my teeth, but I agree that it is for the best.

Out of curiousity, was the extraction/implant process a painful one? What type of anesthesia did you have?

 
Old 04-14-2007, 05:54 AM   #4
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ms58 HB User
Re: Tooth extraction and implant -- immediate or over time? Precautions?

I am not especially fearful of dental procedures so I just went with the topical novacaine and was awake for both the extraction and the post implant. If you prefer, they can give you some light gas to put you out but then you need someone to drive you home. It's just what you prefer.

The actual pulling of the tooth was just a regular pull, yank, some gause and going home and sitting still for a while till the bleeding stopped, ice on the cheek, etc. Just regular tooth pull.

The post implant was a little more of a procedure as they have to get the post correctly into the bone, but as the patient, you don't notice a great difference from a pull. And afterward its the same as the pull, some gause, ice on the cheek, etc. They gave me some mouth rinse to be used after the bleeding stopped. Just be sure they DO NOT give you Peridex mouth rinse, get something else. That makes your teeth turn blueish and my tooth cleaning technician said it is the worst stuff and most dentists don't use it anymore. It took her double time to clean my teeth.

And one more thing. The tooth they put on at the end actually sits above the gum a tiny bit and you will have to loop a piece of dental floss around the tooth bottom every night and kind of wiggle it back and forth to get it clean. Not a huge big deal, but no one told me.

That is all I know. It will take about 5 or 6 months till you are all done, but it is worth it for a lifetime of having teeth.

Good luck and post back if you need any more info.

 
Old 04-14-2007, 09:46 AM   #5
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Re: Tooth extraction and implant -- immediate or over time? Precautions?

Quote:
Originally Posted by walkunafraid View Post
Hi all,

I had a root canal on my bottom left molar a few years ago. Last week, I went in for a cleaning and the hygenist found that the crown was loose. After some further investigation, it was found that bacteria had gotten under the crown and into the tooth, and had caused an infection. As a result, it was determined that I need to have the tooth extracted.

The dentist strongly suggested that I get an implant; she said that if I don't, my teeth will shift over time, the tooth above the molar will lose its use, and I would basically be riddled with dental problems over time. I'm only 28, so I figure I should take her advice rather than risk a lifetime of stressful tooth problems.

Anyhow, she suggested I get the tooth extracted and the implant put in all at the same time. From what I have read here, people most commonly seem to have an implant put it a while after the tooth has been extracted. Is immediate implantation after an extraction a good idea? What are the advantages/disadvantages of doing so?

Also, I am pretty nervous about the implant because a colleague of mine had the same procedure last year and it did not go well. Evidently a nerve in the jaw was struck during the surgery, and she has suffered almost constant pain since then. I can't even imagine going through that, so needless to say I am very worried about getting the implant. Is striking a nerve a common thing during this type of surgery? Are there any precautions I can take to make sure this doesn't happen? Is there any other advice you can give me?

Sorry for my first post being so long...thanks in advance to anyone who can help!
You are right in that most people start the implant process after the tooth is pulled. The implant is not placed in the same day, its just that when you pull the tooth and preserve the socket in the same day, you reduce the chances of losing bone. Some oral surgeons recommend a bone graft to stimulate bone growth after tooth extraction.

If you pull your tooth and wait a few months or years before getting an implant, you may lose a lot of bone, or you may require a lot more dental work before an implant is placed. So it s better to pull the tooth and preserve the socket with a bone graft if needed - on the same day. It is not a good idea to pull the tooth and have the titanium implant placed in the same day, however - especially for a molar. Some people do immediate implants on front teeth for esthetic reasons, but it would not be as successful on molars.

About nerve damage. - yeah, its something I'm worried about too. I am 25, and I am having a lower right first molar implant. Pulled #30 tooth in late January, had socket preservation and bone graft on the same day. Next month I have the implant placed - then I wait another 3 months before the crown is placed. I was told I had a risk of nerve damage b'c it was a lower molar implant.

If you are getting an upper molar implant (I'm geting one as well) you run the risk of damaging the sinus area.

There are risks involved with these procedures, but the best thing to do is to follow your dentists instructions to a T. Know everything you are getting into. See what other options are available. and very important, as another poster said - make sure a specialist (oral surgeon) does the implant procedure - not a general dentist. Make sure you are WELL TAKEN CARE OFF.

I hope this was helpful, take care and good luck!!

 
Old 04-14-2007, 02:07 PM   #6
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walkunafraid HB User
Re: Tooth extraction and implant -- immediate or over time? Precautions?

Quote:
Originally Posted by cheekbones View Post
You are right in that most people start the implant process after the tooth is pulled. The implant is not placed in the same day, its just that when you pull the tooth and preserve the socket in the same day, you reduce the chances of losing bone. Some oral surgeons recommend a bone graft to stimulate bone growth after tooth extraction.

If you pull your tooth and wait a few months or years before getting an implant, you may lose a lot of bone, or you may require a lot more dental work before an implant is placed. So it s better to pull the tooth and preserve the socket with a bone graft if needed - on the same day. It is not a good idea to pull the tooth and have the titanium implant placed in the same day, however - especially for a molar. Some people do immediate implants on front teeth for esthetic reasons, but it would not be as successful on molars.

About nerve damage. - yeah, its something I'm worried about too. I am 25, and I am having a lower right first molar implant. Pulled #30 tooth in late January, had socket preservation and bone graft on the same day. Next month I have the implant placed - then I wait another 3 months before the crown is placed. I was told I had a risk of nerve damage b'c it was a lower molar implant.

If you are getting an upper molar implant (I'm geting one as well) you run the risk of damaging the sinus area.

There are risks involved with these procedures, but the best thing to do is to follow your dentists instructions to a T. Know everything you are getting into. See what other options are available. and very important, as another poster said - make sure a specialist (oral surgeon) does the implant procedure - not a general dentist. Make sure you are WELL TAKEN CARE OFF.

I hope this was helpful, take care and good luck!!

Thank you so much for the advice. It is always comforting to know that I am not alone with this problem.

At my first consultation, bone grafting was not even mentioned. What exactly is that process?

 
Old 04-14-2007, 04:32 PM   #7
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cheekbones HB User
Re: Tooth extraction and implant -- immediate or over time? Precautions?

If the oral surgeon determines that there is not enough bone in the area for the implant, the oral surgeon will place synthetic bone material in the jaw area after tooth is pulled.

The bone graft stimulates bone growth so that when the implant is placed later, the titanium will mesh with the bone and act as a root for the implant.

The procedure is more sucessful if you do the graft right after the tooth is pulled, as opposd to several weeks/months/years after the tooth is pulled.

 
Old 04-15-2007, 08:08 PM   #8
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walkunafraid HB User
Re: Tooth extraction and implant -- immediate or over time? Precautions?

I've been reading about implants all over the Internet and am a bit confused. Some say that bottom back have the second highest rate of failure, and some say that bottom back is the best place for an implant. Can anyone clarify?

 
Old 04-15-2007, 09:38 PM   #9
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Re: Tooth extraction and implant -- or post in cracked root tooth

My front tooth was dark due to a root canal from an injury 21 years ago. My Dentist put a porcelain crown over my tooth after he shaved it down some. 3 years have gone by and I have had about 5 temporary's put on and 3 crowns. All of the crowns broke???? Each time the Dentist put a new crown on he shaved my tooth down more. Now my crown fell off and I couldn't believe what I saw. I barely have any root to attach the crown to. He should not have put the last crown on. He was on vacation for two weeks, so I went to another Dentist and had him put a new temporary on. I also went to an oral surgeon who told me the tooth is and has been shot for a while. He said that I should get an implant, because the root of this tooth is cracked. My original Dentist wants to look at my tooth to see if he can put a post into my existing root. My insurance holds him responsible for this tooth for another two years. I don't know what to do, I don't trust this dentist anymore. I think he should be held accountable to pay for my implant because he was not honest with me about the condition of my tooth. Anyone have any advice?

 
Old 04-16-2007, 04:21 AM   #10
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Re: Tooth extraction and implant -- immediate or over time? Precautions?

Bottom front implants have the higherst rates of success; followed by upper front teeth, then lower back teeth, then upper back teeth. The upper teeth are not as successful as the lower implants because there is not as much bone structure/support as there is in the mandibule (lower jaw).

 
Old 04-16-2007, 10:54 AM   #11
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Re: Tooth extraction and implant -- immediate or over time? Precautions?

In my case all my teeth were pulled, implants placed and teeth attached all in one day. My dental professional is a Prosthodontist. This type of dental professional specializes in tooth replacement. Mine actually specializes in implants. All my implants 8 on top and 6 on the bottom are perfect and I lost none. I personally believe that when one loses their implant it is often the fault of the dental professional and the steps they take to make sure the area is completely free of germs and to make sure one has enough bone to support the implant.

I also believe that a dental CT scan is very important. The dental professional can see exactly where the nerves are and therefore prevent any nerve damage.

My prosthodontist also uses PRP which is platelet rich plasma. They take your own blood and subtract the platelets from the blood and since platelets are naturally sticky they put this in the drilled implant socket and dip the implants in the platelets creating a barrier for germs and it speeds healing.

I think the reason dental professionals opt to go the old more traditional route is that is the method they are most comfortable with. A friend of mine and I had our implants placed at the same time with the same amount of implants except that my teeth were attached and she wore a modified denture. Both of us had the exact same experiences in healing and the exact same outcome.
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Old 04-17-2007, 03:21 PM   #12
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walkunafraid HB User
Re: Tooth extraction and implant -- immediate or over time? Precautions?

Thank you so much everyone for the advice and help. It is really very appreciated.

I went to a friend's dentist today for a second opinion. My plan has always been to go see a specialist, but I am not able to get to see one for a couple more weeks, so I went to see this second dentist because my friend said that he is really good and caring. I figured that it couldn't hurt to see a second dentist; I was just seeking his advice, knowing that if I was going to get the implant, I would make sure it would be done by a specialist in that field.

Anyway, he had a look at my tooth and confirmed that it needs to be extracted. However, when I asked about an implant, he was a bit hesitant to recommend one. He basically said that back molars are not very important in terms of appearance (obviously), but also because we don't rely on our molars to chew anymore as the "cavemen" once did because we don't have as heavy a reliance on meat in our diet.

I asked about the tooth above the one that is going to be pulled "falling down" since it won't have anything to bite on, and he said this only happens to less than 20% of the population who have a tooth pulled.

I asked about teeth shifting, and he said that my teeth are already close together, so it won't be that big of a deal.

I asked him why he was hesitant about an implant, and he said that he feels that way because the science of implanting a tooth is not yet perfect, and there are many things that can go wrong. He advised that I could always get an implant a little further down the road, when the science has been improved even more and success rate is closer to 100%.

My first reaction to all of this was relief, since I have been dreading an implant since I was told that I need one. Afterward, however, I couldn't help feeling a bit worried -- the dentist did seem kind of "old fashioned," and with two bits of advice from two different dentists, I don't know which is best to follow. Both certainly scared me into following their advice, so I feel like I'm being pulled two different ways with no clue which way to go.

What do you all recommend? Has anyone ever had a back last molar pulled without getting an implant? If so, have there been any negative consequences?

Thanks...

 
Old 04-17-2007, 04:30 PM   #13
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Re: Tooth extraction and implant -- immediate or over time? Precautions?

Over the years your teeth will shift and your bite will become uneven. The tooth above will get loose and your jaw will lose bone. So at some point you will have to have major dental work to restore the area. Ofcourse, nothing is absolute and maybe some of your teeth will shift and you'll not have problems.

It seems that in 2007 you should not be walking around with a missing tooth if you can afford to get an implant. I would say tough it out (your screen name is walk unafraid so you should be strong), see the specialist and take the chance on the implant.

You are young and should not leave your teeth to chance at 28, maybe if you were 68 OK, but not at your age.

I vote go with the implant.

Last edited by ms58; 04-17-2007 at 04:34 PM.

 
Old 04-18-2007, 10:45 AM   #14
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Re: Tooth extraction and implant -- immediate or over time? Precautions?

I'd get a second opinion. This dentist doesn't sound very knowledgeable about implants. My doctor is part of a team of doctor's who are Prosthodontists, and has shown me his own research in his office alone and he does hundreds of implants as well as treats hundreds of patients, a year that they have a 98% success rate per implant and a 100% success rate per patient. What I mean by 100% success rate per patient is they work like crazy to make sure all patients have a beautiful smile. No matter what it takes.

Just because you may lose an implant doesn't mean it can't be removed and put back in when the area heals. Another way of dealing with a lost implant is for example lets say they place 8 implants on top and one fails you still have 7 that will work fine. Understand?

The success rate falls squarely on the dental professional. The one you consulted doesn't have the skills needed apparently from his own advice to tell you about implants.
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Last edited by anitak1982; 04-18-2007 at 01:03 PM.

 
Old 04-18-2007, 11:04 AM   #15
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Re: Tooth extraction and implant -- immediate or over time? Precautions?

everyone is different and built differently. Don't wait.

 
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