# After tooth extraction, is a dental implant really necessary?



## purple_cloud

I'm not sure if this best belongs here or in HL - mods do what you deem appropriate with it.

Anyway, I had a tooth extracted a few days ago, it's one of the molars all the way in the back. It had been root canaled about 12 years ago, and in the last 6 months started causing a lot of pain as well as 3 dental abscesses.

Now that the tooth has been extracted, the oral surgeon and my dentist are talking about placing a dental implant. Do any of you guys have any knowledge on this? I've spent a lot of time googling, and I can't seem to find what I'm looking for. And, unfortunately, I feel as if the dentists aren't going to be real with me because this procedure is relatively expensive (close to 2k was the quote they gave me). I also have TMJ, and according to wiki, bruxism (teeth grinding) tends to cause implants to reject --- I do not want to pay all of this money for something that is going to cause more pain, more problems, and cost more money. 

Basically, there's only one tooth behind the one that is now gone...is it really that important I have an implant placed so soon, or can it wait a few years until I have money and dental insurance?


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## poopie

Right off the bat, I am going to give you a definite *YES*!!!

Now, I am going to explain why!

10 years ago, I had a molar extracted as well, bottom left, with one molar left behind it. This doctor (oral surgeon) was telling me to get an implant, as well. I brushed it off, because after spending those couple of hundreds of dollars on the extraction and presciptions to go with, I was not about to spend a couple of GRAND on an implant. Little did I know what would happen...

Fast forward to about 7 years later...I have now started taking excellent care of my teeth and my dentist is hassling about an implant. Here's why- the last molar (adjacent to the empty space) has now become the Leaning Tower of Pisa. It's still quite functional and causes me no pain, but it was only going to get worse. It was only a few millimeters from caving into the next tooth as well. Oh, and to make things better, we had seen via x-rays that I was suffering some bone loss due to the missing tooth. There is a slight divot in my gum line there.

Well, I thought maybe we could just implant a smaller tooth in that place, but as everyone knows, there is never an "easy" way about dentistry. So, off I go to the orthodontist. I had to have that tooth straightened up before I can get an implant. And, a few months before I am ready to get my implant, I will have to have a bone graft too, to help regenerate the missing bone in my jaw, and to make sure the bone will hold the tooth. 

I'm already in $4,000 for the braces, god knows what the bone graft will cost, and then about $2,000 for the implant. And due to it all being considered cosmetic by health insurance companies, it will all come out of my very poor pockets. =(

So, save your pennies, and do it. SOON!

:D


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## purple_cloud

Thanks poopie, although that wasn't what I wanted to hear, hehe. Yeah the bone graft will be necessary, they want to wait about 3 months for the extraction to heal. There's only one tooth behind it, since my wisdom teeth were removed a few years ago. I'm just a little nervous about the implant rejecting, since I have TMJ disorder and multiple sources say that bruxism tends to cause rejection -- the idea of paying all this money for nothing makes me sick. 

And, I had braces about 11 years ago, the idea of needing them again makes me want to listen to you. And, I still have a hard time with these things being considered "cosmetic" because clearly they are necessary. I guess if insurance won't pay for the implant later down the road, may as well do it now through my college's oral surgery clinic (a student did the procedure, and I feel as if I paid the same price a full-degreed oral surgeon would cost, too. They claim to be cheaper but it seems they only are for anything that does not involve an implant =(  ).


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## Busty St Clare

Another thing to consider is the lower molar opposite the extracted tooth will eventually over erupt into the space above, which can also disrupt your occlusion. This generally results in TMD as well. How long this will take varies from patient to patient but after 2 yrs I would normally expect some drift of the back molar.

*NSFW*: 










Your concerns about bruxing is not nesessary as all the dentist has to do is take particular care when designing the bite. If you have TMD issues he/she should be aiming to create canine guidance, which means when you do grind the back molars are proped open and any sideways forces are taken away from the implant.

The other option you have would to have braces again and pull the back molar forward.

2 grand is relatively cheap for an implant if you ask me. (I generally charge $US5000, more for bone grafts).


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## purple_cloud

Thanks Busty, I have a question though: 


 would it be possible to pull the other molar forward with some other sort of orthodontic device, like a retainer? I mean at this point I'll probably go through with the implant, but just want to make sure I know what all my options are.

Another question for you:
 I haven't followed the rules well at all, particularly the no smoking one --- still smoking cigs and pot from my bowl. It's day 3, the area is still swollen, hot, and throbbing (its been on and off infected for the past few months, i'm on antibiotics but I get the feeling they aren't working). Does this sound like I can just wait until my scheduled appointment on Monday? I'm just hoping it's not a dry socket beginning to form...


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## Changed

call the dentist and ask him? he probably knows better than we do.


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## poopie

Dude! You gotta listen to the dr and take care of that area! Ugh, I couldn't imagine dry socket! Call the doc, but take care of yourself and be sure to follow our prescriptions to a T! 

I briefly talked to my orthodontist about simply pulling my last molar forward. He said it was an option. The problem, he said, is that it would take several years. He said that teeth need to be moved slowly, or you risk...well, them coming out. I've had braces for 18 months now, and he said to move that molar would take approx. 3 years. 

I also had what Busty mentioned as well, the supra eruption. The molar on my upper jaw had dipped down a bit, due to not having an opposite tooth to constantly push back against it. 

I'm very glad we ha an expert step in here. 

Oh Busty, you _dentie_!!!

/anti-dentite epithets


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## Busty St Clare

purple_cloud said:


> Thanks Busty, I have a question though:
> 
> 
> would it be possible to pull the other molar forward with some other sort of orthodontic device, like a retainer? I mean at this point I'll probably go through with the implant, but just want to make sure I know what all my options are.
> 
> Another question for you:
> I haven't followed the rules well at all, particularly the no smoking one --- still smoking cigs and pot from my bowl. It's day 3, the area is still swollen, hot, and throbbing (its been on and off infected for the past few months, i'm on antibiotics but I get the feeling they aren't working). Does this sound like I can just wait until my scheduled appointment on Monday? I'm just hoping it's not a dry socket beginning to form...



Sounds like a dry socket may be forming. Just go back and get it cleaned and dressed, should take about 3 minutes to fix. Antibiotics have no affect on dry sockets as it's more exposed bone than actual weeping puss.

A removable retainer won't have enough anchorage generally to pull a molar forward. Depending on the distance you can sometimes get away with 3-4 button type brackets and perhaps a rubber band just on a handful of teeth on that side. You just have better control with brackets and wires. Bare in mind I have an orthodontist in my practice so I don't have to do shit with regards to these cases. I will often smile and nod and rebook them with him.


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## purple_cloud

I do have a follow-up appointment on Monday where I'm going to discuss this with the student and oral surgeon, it's sort of a pain in the ass using the school clinic because you get a different person everytime and even though they have xrays and records, you need to re-explain EVERYTHING. I just figured I'd get some other opinions so I have some sort of knowledge about it, and other first hand experience. 

If the area is not feeling any better tomorrow (day 4) I will call the office and see if I should still wait until Monday. However, the oral surgeons are apparently there only certain days, and the first time I called with the problem originally, I was told it was NOT an emergency, and sent to the ER, which I have a huge ass bill from because my insurance decided NOT to cover it since it involved my mouth. It took me FOREVER to get an appointment with them, and twice as long for my new regular dentist to get the referral, thus leaving me in pain with this issue for over a month already. Having it pulled was a relief.

Sorry for the rant, but this is why I'm trying to get as much info as I can from my own research on this...I feel like they're dicking me around, and if I don't educate myself they are going to end up screwing me...my university is super good at that.



EDIT:   I feel like I'm not having the pain a dry socket should cause...and the area was infected when they removed the tooth, which was why they gave me antibiotics in the first place.


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## Samadhi

poopie said:


> Right off the bat, I am going to give you a definite *YES*!!!
> 
> Now, I am going to explain why!
> 
> 10 years ago, I had a molar extracted as well, bottom left, with one molar left behind it. This doctor (oral surgeon) was telling me to get an implant, as well. I brushed it off, because after spending those couple of hundreds of dollars on the extraction and presciptions to go with, I was not about to spend a couple of GRAND on an implant. Little did I know what would happen...
> 
> Fast forward to about 7 years later...I have now started taking excellent care of my teeth and my dentist is hassling about an implant. Here's why- the last molar (adjacent to the empty space) has now become the Leaning Tower of Pisa. It's still quite functional and causes me no pain, but it was only going to get worse. It was only a few millimeters from caving into the next tooth as well. Oh, and to make things better, we had seen via x-rays that I was suffering some bone loss due to the missing tooth. There is a slight divot in my gum line there.
> 
> Well, I thought maybe we could just implant a smaller tooth in that place, but as everyone knows, there is never an "easy" way about dentistry. So, off I go to the orthodontist. I had to have that tooth straightened up before I can get an implant. And, a few months before I am ready to get my implant, I will have to have a bone graft too, to help regenerate the missing bone in my jaw, and to make sure the bone will hold the tooth.
> 
> I'm already in $4,000 for the braces, god knows what the bone graft will cost, and then about $2,000 for the implant. And due to it all being considered cosmetic by health insurance companies, it will all come out of my very poor pockets. =(
> 
> So, save your pennies, and do it. SOON!
> 
> :D



I'm in the same position as you, Poopie .  After a check up of my teeth recently and x-rays, it seems that a problem has come back - which has now brought up an issue of whether i should get a dental implant... the problem is that my endodontist doesn't think there is enough bone to implant anything in its "as is" state(i had the tooth extracted a decade ago), so if i do go down that road, i will have to have a bone graft.  I'm in the same boat as you, having spent around the same amount of money in the past couple of years on my teeth, only to have this as well.  Also, i'm getting married in October, and the other work (along with the potential implant) would impact on my smile if i were to get it done before then, so i'm waiting until after.  I wish i'd gotten a dental implant now *sigh*. Fucken.


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## maya32

The best thing you can do now is to just get another dentist to check your situation and see if the solution is the same. I can give you a reliable resource on dental implant Beverly Hills, it's where I had my dental work done. You should find the support you need here, I was very satisfied with their services. I hope you'll find the best way to solve your tooth problem.


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## purple_cloud

^ Unfortunately, that place is a good solid 3000 miles from where I live. However, I did follow-up with my regular, trusted dentist, as well as my orthodontist. For now, I have two different mouth guards to help keep my bite aligned and hold the space open until I'm able to afford a dental implant.


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## wooger

I just kinda skimmed your post... but I had the exact same tooth out as you several weeks ago! 

To be honest, I think an implant is a bit extreme, they are really expensive and I believe you have to go in for surgery for surgery on your jaw if you have an implant. 

Maybe ask your dentist about a bridge as an alternative to an implant? It's basically a fake tooth which is connected to teeth either side of it, and is alot less hassle than full on surgery and cheaper too... not sure if they last as long as implants though..

either way its something to ask your dentist about


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## purple_cloud

My dentist and I had a lengthy discussion, as did my orthodontist and I. The problem with a bridge is, it requires them touching the neighboring teeth, and doesn't tend to last quite as long, so they would rather not go with this approach. I don't care about having a missing tooth, its just that it caused all of my other teeth to shift, so my bite is not aligned at all whatsoever --- and thus it is making my TMJ 10x worse. If it was purely aesthetic, an implant is the last thing I want --- several oral surgeries over the course of a year, with all that pain? No thanks. And, the bone did grow back, my dentist said they were idiots for even suggesting a bone graph on someone as young as I am. Sooo, the implant is going to be necessary eventually...I'm just hoping these little orthodontic contraptions can hold things off for a while.


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## TINK

I have spent my entire life in the dentist chair, or at least it feels like it. I have an autoimmune disorder where I don't produce enough saliva, which is your body's antibacterial agent for your teeth.  Along with being hit by a car when I was three and getting all 6 of my front teeth knocked out and having 6 years of braces.  I would have to say that there are probably 3-4 teeth in my mouth that have not had any work done on them.  

I even spent a week in the hospital due to an infection.  All 4 of my front teeth abcessed at the same time and the infection settled in my facial tissue. If it would have gotten into my blood stream I could have died. 

So, my advice, don't mess around when it comes to your teeth. Get into the dentist and get it taken care of. It is so sad that in this day and age they consider dental and vision pretty much optional or a luxury when in comes to insurance. How is it different if my tooth gets infected versus my ear?  It doesn't make sense to me.

good luck


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## purple_cloud

Yes, I have SHITTY health insurance, seeing a psych dr and counselor are eating up all of the allowance I have left. ZERO vision or dental coverage at all whatsoever, and the cheapest an implant would be, if my dentist hooked me up with the residents he supervises at the hospital, would still be around $3k. I went to the ER when the tooth first abscessed, and I figured, oh, who cares if it's in my mouth...apparently my insurance did, that $100 deductible didn't do shit, and ended up paying about $600 more in medical bills. I'm not messing around, that's why my dentist sent me to the orthodontist (who I already know pretty well, seeing as I had braces, retainers, various TMJ contraptions, etc) and gave me these plastic things to hold things off for now. Really, I don't want to deal with the pain or aggravation at this point in my life, so knowing I can put it off for a while because I have devices to help me do so, really does give me some piece of mind about it. I also have horrible teeth, and spend WAAAAAAAAAAY too much time at the dentist/orthodontist/oral surgeon, and it all needs to get paid in full.

Don't get me started on adding the cost of vision correction into this too, and that my insurance company is being a fucking asshole about psychiatric care, and once I lose my insurance in August, I'll be paying at LEAST $400 a month just for medications, including my birth control which I also need to be on for medical reasons. I don't even wanna get into the lower back issues I have here which have required a fucking expensive MRI and I'm trying to avoid even going near an orthopedic surgeon for a consult. Seriously, what the fuck with all of this, either I need to be normal, or find a way to get my insurance to actually pay for shit while I still have it, which doesn't seem very likely at all whatsoever.


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## User Name Here

I have two dental implants after knocking those teeth out during a seizure in 2008. I don't think it's necessary to have an implant, honestly. I maintained a bridge for a year before getting the implants and could've stuck with that, honestly. The only problem was there was A LOT more maintenance involved with keeping bridgework up.

The dental implants were the best thing I've ever had done as far as my mouth goes! They healed very quickly and were pretty much painless. It took two procedures to conclude: the first one in which they implanted two 3" steel rods into my jaw bone and the second one in which they went back and added the teeth after the gums had healed up nicely. I have had these implants for approximately two years now and they're seriously even better than my real teeth. They feel like real teeth and are extremely solid. I definitely recommend them but I know how expensive they are and if your health insurance doesn't hack it, I can imagine why this would seem like a not-so-good route.

Has your dentist not discussed any other options with you? Because there are several other avenues you could take instead of dental implants. 

Also, purple, I feel your pain with health insurance. I just lost mine not a week before getting into that massive car wreck which sent me to the hospital (in an ambulance that cost 2k for the five minute ride, no less). Thank god (or whoever) my car insurance footed the bill or else, well, I don't know what the hell I would've done. Anyway, my epilepsy meds alone cost 2k a month without insurance and just over 1k on the Walgreen's prescription plan (which I highly recommend in addition to insurance, by the way!). Thankfully I just got married to a Marine so I get all of his Tri-care insurance (which is what I had before via my stepdad) and that's some of the best insurance you can get. 

Anyway, I hope you figure something out! Just remember there are indeed other options and you are not alone when it comes to being pissed off about having health issues and shitty insurance  If you ever need to vent, you know where to find me.


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