First molar extraction: implant, braces or leave gap?

JamesH2888

maisie_cat said:

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.

Oh wow, were the extractions done long ago? Have you had any issues with other teeth shifting around or tilting into the space? Just wondering as I've read that can be a problem. Cheers.

JamesH2888

Mands said:

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.

Thanks for sharing. It's good to know the implant worked well for you. Did you get a bone graft at the extraction site when the tooth was extracted? What were all the appointments for?

I've been told it would be best to have a bone graft at the time of extraction (I have some bone loss due to the cracked root issue), then they'd take another CBCT scan a few months later to check if the bone graft worked and whether there was enough bone for an implant. If there wasn't, I'd have the option of having another bone graft, and presumably another few months' wait and then another CBCT scan to check again.

Not super keen on the idea of having lots of CBCT scans given the radiation exposure, and seems potentially a very long-winded process, but worth it ultimately I suppose for a good result.

SuzeQStan

JamesH2888 said:.

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?

Not sure - it’s visible from the side but now that he has the temporary filling I don’t notice it anymore. The temp filling is ‘tooth colour’ if that makes sense.

I don’t know if the temp filling would prevent tooth movement - probably one to ask your dentist.

problem with dentists these days is now they are mostly private they are incentivised to steer their patients into costly treatments. 

I understand why they do it but sometimes The cheaper options are no worse than costly ones.

Mands

JamesH2888 said:

Mands said:

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.

Thanks for sharing. It's good to know the implant worked well for you. Did you get a bone graft at the extraction site when the tooth was extracted? What were all the appointments for?

I've been told it would be best to have a bone graft at the time of extraction (I have some bone loss due to the cracked root issue), then they'd take another CBCT scan a few months later to check if the bone graft worked and whether there was enough bone for an implant. If there wasn't, I'd have the option of having another bone graft, and presumably another few months' wait and then another CBCT scan to check again.

Not super keen on the idea of having lots of CBCT scans given the radiation exposure, and seems potentially a very long-winded process, but worth it ultimately I suppose for a good result.

I was told to leave at least 3 months after the extraction before the graft. It ended up being much longer than that, maybe a year.

Appointments:
So, extraction and a followup for that.
Bone graft and a followup I think
Implant and a followup
Uncovering the implant
Then back to the dentist who needed 3 appointments to make and fit the new tooth

If that list is correct then, excluding the extraction, 5 visits to the surgeon and 3 to the dentist.

Both the dentist and the surgeon are popular so some of the scheduling (appointment B must be 10-14 days after appointment A sort of thing) was a logistical challenge. 

Disclaimer: I am outside of the UK so the process here might be different, as is the pricing.

Torry_Quine

JamesH2888 said:

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.

My extraction was four years ago. Chewing is no problem. The adjacent teeth haven't moved. 

JamesH2888

Mands said:

JamesH2888 said:

Mands said:

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.

Thanks for sharing. It's good to know the implant worked well for you. Did you get a bone graft at the extraction site when the tooth was extracted? What were all the appointments for?

I've been told it would be best to have a bone graft at the time of extraction (I have some bone loss due to the cracked root issue), then they'd take another CBCT scan a few months later to check if the bone graft worked and whether there was enough bone for an implant. If there wasn't, I'd have the option of having another bone graft, and presumably another few months' wait and then another CBCT scan to check again.

Not super keen on the idea of having lots of CBCT scans given the radiation exposure, and seems potentially a very long-winded process, but worth it ultimately I suppose for a good result.

I was told to leave at least 3 months after the extraction before the graft. It ended up being much longer than that, maybe a year.

Appointments:
So, extraction and a followup for that.
Bone graft and a followup I think
Implant and a followup
Uncovering the implant
Then back to the dentist who needed 3 appointments to make and fit the new tooth

If that list is correct then, excluding the extraction, 5 visits to the surgeon and 3 to the dentist.

Both the dentist and the surgeon are popular so some of the scheduling (appointment B must be 10-14 days after appointment A sort of thing) was a logistical challenge. 

Disclaimer: I am outside of the UK so the process here might be different, as is the pricing.

Thanks for the info and rundown on the appointments. Good to know it all worked well in the end. So, you didn't get a bone graft at the time of extraction and waited about a year before getting one?

JamesH2888

Torry_Quine said:

JamesH2888 said:

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.

My extraction was four years ago. Chewing is no problem. The adjacent teeth haven't moved. 

Thanks for the info. Was it a first molar, do you know (first of the large teeth on the side)?

Mands

Thanks for the info and rundown on the appointments. Good to know it all worked well in the end. So, you didn't get a bone graft at the time of extraction and waited about a year before getting one?

That's my recollection, yes. The jaw fractured during the extraction so waiting longer worked in my favour in that, by the time i went back for the graft, the jaw bone had had plenty of time to heal.

Kim_kim

35har1old said:

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.

3 months is about the optimum time.