First molar extraction: implant, braces or leave gap?

JamesH2888

I’m 42 and currently have all my adult teeth. I have a few composite fillings but have had no dental work other than that.

Unfortunately, a CBCT scan has revealed a cracked root in my UL6 (first molar), with extensive external root resorption, which apparently means the tooth is unrestorable. The tooth isn’t causing me any pain but I’ve been told that it needs to be extracted.

Coincidentally, before getting the scan, I was considering orthodontic treatment to improve the appearance of my front teeth, which are slightly crooked, with some uneven wear occurring on the edges of my upper central incisors that I’m told is caused by my bite.

I’m now torn between three treatment options, all of which I can afford (albeit by using savings), after I’ve had the UL6 (first molar) extracted:

1) Get in implant after extracting the UL6 (first molar)

2) Attempt to close the gap left by the UL6 (first molar) using orthodontics/braces

3) Just leave a gap where UL6 currently is

I’ve had consultations with two orthodontists and two non-ortho dental specialists who have conflicting opinions, so am pretty confused and unsure what route to go.

Orthodontist 1 is confident they can close the UL6 gap with braces and advises against leaving a gap there.

Orthodontist 2 says it’s best to not try to close the gap and instead just correct the front teeth and either leave the gap or have an implant.

I’d be grateful for any views/input from dentists or orthodontists on what the best option would be, and whether trying to close the gap orthodontically is advisable.

Also, does anyone have any experience of having gaps in their teeth left by a molar extraction closed with orthodontics? If so, did it work for you?

Many thanks.

silvercar

Leave the gap for a few months and see how you get on living with the space. No rush to make a decision.

35har1old

JamesH2888 said:

I’m 42 and currently have all my adult teeth. I have a few composite fillings but have had no dental work other than that.

Unfortunately, a CBCT scan has revealed a cracked root in my UL6 (first molar), with extensive external root resorption, which apparently means the tooth is unrestorable. The tooth isn’t causing me any pain but I’ve been told that it needs to be extracted.

Coincidentally, before getting the scan, I was considering orthodontic treatment to improve the appearance of my front teeth, which are slightly crooked, with some uneven wear occurring on the edges of my upper central incisors that I’m told is caused by my bite.

I’m now torn between three treatment options, all of which I can afford (albeit by using savings), after I’ve had the UL6 (first molar) extracted:

1) Get in implant after extracting the UL6 (first molar)

2) Attempt to close the gap left by the UL6 (first molar) using orthodontics/braces

3) Just leave a gap where UL6 currently is

I’ve had consultations with two orthodontists and two non-ortho dental specialists who have conflicting opinions, so am pretty confused and unsure what route to go.

Orthodontist 1 is confident they can close the UL6 gap with braces and advises against leaving a gap there.

Orthodontist 2 says it’s best to not try to close the gap and instead just correct the front teeth and either leave the gap or have an implant.

I’d be grateful for any views/input from dentists or orthodontists on what the best option would be, and whether trying to close the gap orthodontically is advisable.

Also, does anyone have any experience of having gaps in their teeth left by a molar extraction closed with orthodontics? If so, did it work for you?

Many thanks.

As far as I'm aware you do have to leave time between extraction and most procedures. But likely to be offered a denture in the mean time.

SuzeQStan

Same thing happened to my OH 3 weeks ago - options were an implant (3k), a bridge (dentist would have to file down the healthy teeth either side to do this so not ideal), a temporary filling or do nothing.

he went with the temporary filling - cheapest option (aside from doing nothing) and keeps food out of the tooth socket. 

And like others have said you can always think about it and change your mind down the road if you are really missing that tooth.

personally I wouldn’t get an implant for a back tooth as it’s just too costly for me.

Torry_Quine

I just left the gap when I had mine removed. It's not caused a problem 

maisie_cat

I have 5 lower back teeth missing and just left them for cost reasons. Four of them were milk teeth that didn't come out so the gaps are small. The only time I notice is if we buy crusty bread and it bothers my gums.

35har1old

SuzeQStan said:

Same thing happened to my OH 3 weeks ago - options were an implant (3k), a bridge (dentist would have to file down the healthy teeth either side to do this so not ideal), a temporary filling or do nothing.

he went with the temporary filling - cheapest option (aside from doing nothing) and keeps food out of the tooth socket. 

And like others have said you can always think about it and change your mind down the road if you are really missing that tooth.

personally I wouldn’t get an implant for a back tooth as it’s just too costly for me.

A bridge may only require one good tooth to act  as anchor

Mands

JamesH2888 said:

Also, does anyone have any experience of having gaps in their teeth left by a molar extraction closed with orthodontics? If so, did it work for you?

Many thanks.

I had a molar extracted about 4 years ago, it may have been UL6. I chose to have an implant in its place.

I wasn't concerned about the gap itself but more about how the other teeth would react to it. I had warnings from friends, backed in part by questions to my dentist and dental surgeon, that the other teeth would lean into the gap and in addition to the dental problems that might cause I might also find the shape of my face change. I'm female and ten years older than you, for context.

I'm very happy with the decision but I wish I'd known before hand just how long the whole thing would take. The process was made worse by Covid and delays due to some personal factors but it felt like a lot of appointments over the course of a year or more.

JamesH2888

silvercar said:

Leave the gap for a few months and see how you get on living with the space. No rush to make a decision.

Thanks. That's true. Though if I'm going for an implant, apparently it's best to get a bone graft done at the time of extraction.

JamesH2888

SuzeQStan said:

Same thing happened to my OH 3 weeks ago - options were an implant (3k), a bridge (dentist would have to file down the healthy teeth either side to do this so not ideal), a temporary filling or do nothing.

he went with the temporary filling - cheapest option (aside from doing nothing) and keeps food out of the tooth socket. 

And like others have said you can always think about it and change your mind down the road if you are really missing that tooth.

personally I wouldn’t get an implant for a back tooth as it’s just too costly for me.

It is very costly. :-( If it was right at the back of the mouth, I think I'd probably just leave it as an empty space, but the first molar is the main chewing tooth and apparently other teeth can move or tilt into the gap if it's left empty.

Is your OH's tooth a first molar? I haven't been offered a temporary filling. Interesting to hear. Is that to stop neighbouring teeth moving into the space?

JamesH2888

Torry_Quine said:

I just left the gap when I had mine removed. It's not caused a problem 

That's good to know. How long ago was the extraction? Was your missing tooth a first molar? Guess you've found that you can chew okay without it?

I'm considering just leaving a gap but I've read that over time neighbouring teeth are likely to move or tilt into the space, which could cause problems such as decay as the tilting teeth then become difficult to clean properly.