Dental implant (back molar)

[ElizabethVonArnim]

This summer, I had to have a back molar removed along with the wisdom tooth that was pushing against it. I now have quite a big gap at the back and just one big molar on that side (lower right).

The relief of not having the constant pressure of the two teeth grinding against each other, constantly having to find ways to extract bits of stuck food etc is more than I ever dreamed, so the extraction has really worked for me.

My dentist now says that I should have an implant (£2500) as this will protect my remaining molar and give me more to chew with.

To be honest, I'm a bit suspicious as the dental surgery I go to has just changed its name to (xxx dental surgery and implant centre).

I'm also anxious that if they get the size and shape of the implant even a fraction wrong it will be back to the old days of having an annoying tooth.

And I'm worried it will hurt if they have to drill into bone (the extraction really hurt, although I am pleased now and I recovered well without complications). And it's really bloody expensive.

Has anyone had a molar implant? Is it worth it? Any other info eg pain levels, the process, is it annoying once in, etc, really appreciated.

I wouldn’t bother! From how you describe it it doesn’t show, as you say it will hurt, cost and you can chew on the other side.

I have had an implant at the back of my mouth and on balance I do not regret it. My (admittedly limited) understanding of tooth loss is that it can set up a kind of 'chain reaction' on the other teeth, which can weaken the other teeth over time.
I also wasn't keen on developing that sunken cheek look of the toothless elderly as I aged.
I have to be honest and say that the drilling didn't hurt but the healing was not without pain - not agony but definitely toothache territory.
Implants supposedly last around 25 years, so I considered it a good investment in the preservation of my body. I have had no problems with the implant at all.

I had an implant at the back of my mouth and the only part that hurt was when I went back to have the crown screwed on. If you don’t have the implant you will eventually have to have the tooth at the top filed down. They are careful to match the colour and size but, personally, if you are talking about the molar at the very back, I wouldn’t bother. You have had a reasonable quote, by the way, as an implant generally costs £3000 although you do pay in stages.

I have had all my wisdom teeth removed and a couple of years ago then had the last molar at the top removed too. We discussed the possibility of an implant at the time but I didn’t have one. You can’t tell there’s no tooth there, my other teeth haven’t moved, I have no issue with chewing on that side and I certainly haven’t needed the matching molar below filed down! Human teeth are not like rabbit’s teeth - they don’t continue to grow so don’t need grinding down!!!
Your dentist is just trying to make money out of you.

I lost two back teeth (top and bottom, different sides) and didn't have implants because I couldn't afford it and nobody could see. However, my teeth have all moved over the years and I've gone from having beautifully straight teeth, to slightly protruding and crooked, I'm very self-conscious. I managed to have the implants this summer and I'm now thinking about some kind of braces to try and straighten up my teeth.

The drilling didn't hurt, the only thing that was uncomfortable was screwing the tooth on to the implant but even that stopped hurting after a couple of minutes.

Thank you all. I'm still in a bit of a quandary about it but this is all really useful info. Nice to hear from people who've had it rather than the dentist who wants to do it!

I’m a dentist. I had all my wisdom teeth removed at 18. Then one of my back molars removed 20yrs ago.
I have never, ever missed the back molar. It doesn’t affect my chewing capacity and it’s a handy spot to park a mint or chewing gum if I need to talk.
From a professional point of view:

1. is it necessary for chewing - unlikely since even if you have all your molars removed, 12 teeth in total if you include the wisdom teeth, you only reduce your chewing capacity by 20%. It’s loss of the premolars, the little double test towards the front that actually are much more valuable.
2. does the gap bother you
3. are you concerned about the appearance

There are very few instances I would recommend an implant to replace a second molar, the main one being if the remaining molars are in poor condition, and there is a possibility you will lose more teeth in that quadrant in the future as a result of their poor condition.
As dentists we are sort of programmed to think that every tooth should be restored or replaced. In reality people can function with very few teeth and many of the major restoration treatments actually shorten the life of the teeth. The older you get, as a dentist, the more you realise that elective removal of healthy tooth tissue, such as crowns and bridgework for purely cosmetic reasons, the more you shorten the life of the tooth.
Implants are not end stage, in other words they can fail and they do need regular maintenance. You should see an implantologist annually and the implant will need specialist cleaning at least twice a year.
They have been around long enough for us to realise they are not as permanent as we first thought.
Personally, I’d use the money for a nice holiday.
I think you are probably correct in your assumption that the practice you attend has an invested interest in suggesting an implant.
The important thing to know is that no implant is necessary, it is an option. Nothing bad will happen if you chose not to replace the tooth. In addition, you can always have it done at a later stage.
We have had an implantologist in our practice for four years. It’s great to refer patients to him but he gives patients every option available including do nothing. First and foremost he will never convince a patient that an implant is necessary or the only option. He also gives patients as much time as they need to decide.

Thank you so much, AngryMum. The remaining big molar does have a filling which has been replaced once (amalgam replaced with white filling) so it is definitely the most vulnerable bit of my mouth, but I am not bothered about the appearance at all - as you say, the gap is a nice hiding place! I would only do it to protect the other tooth; otherwise, I would rather do nothing.

With that tooth being in slightly shabby condition (never had any issues with it since the filling, though), would you think that this makes the implant a better idea or does it make no real difference?

The issue with a gap is the tooth above or below it won't have anything to push against (which helps to keep the bone strong) when chewing. So you risk losing the tooth above or below it. As well as the teeth surrounding that gap will also be subject to bone loss. So in that sense it is probably worth it.

I had a molar removed over 15 years ago. No other teeth have shifted, and the teeth above it are fine.

I have seven implants. It’s no picnic to have them put in, and it’s bloody expensive, but if you can find the money, do it. If you take good care of them they last for life.

Just be aware that without the back tooth, you can clean the one remaining much more easily. Placing an implant will recreate what we call an interproximal space. This space is much harder to clean so effectively puts the remaining toot at risk of decay on the back surface.
It is true that an implant tooth is sometimes recommended to stop the opposing tooth in the top jaw from moving downward s into the space but studies have shown that this is not high risk in patients with no gum disease. Like most of the advice we give it’s based on historic observation when oral hygiene and health was poor. It’s worth having a discussion about this with your dentist. You only need a fraction of contact between the upper tooth and the remaining lower molar for it to be stable.

I have patients who have had filled teeth for 70+ years so just because your remaining molar is filled doesn’t necessarily mean it is at risk. I think people assume that you use the remaining teeth more when others are removed. In fact you chew no differently. The tooth is just as likely to fail if you have the tooth behind or not. Without going into boring dental speak, a tooth will become more fragile the more times it is refilled. A lot of damage is done when you drill teeth with high speed diamond drills because the friction can cause super high temperatures and if they are not cooled sufficiently they overheat the tooth and cause fractures. Going back to the 70s and 80s when high volume suction wasn’t available, dentists just switched off the water spray. We see a lot of fracturing in patients who are 50+ because of historic thermal fracturing.
Sorry I went off on a tangent. I was involved in the early research of the causes of fracturing a few years ago. No one could explain why some patients were suffering lots of fractures. We asked them a simple question “ did they remember a strong smell of burning when their dentist filled a tooth” incredibly it was almost an unanimous yes.
What triggered my interest was the number of patients who would comment on how much nicer it was to have a filling without it smelling of burning tooth. This was in the late 80s and early 90s. As students we used to be sent off clinic if burning tooth smell was detected. They were aware of the thermal damage causing post op pain, but it was a few years before it was apparent how much long term damage it caused.

I had a back molar removed and decided to leave it and not replace it with a bridge or dental implant. But years later the tooth next to it broke and my NHS dentist attributed this to it having to bear the extra weight when I bit down, owing to the missing tooth. She repaired that tooth but recommended me to find a private dentist to do an implant, as this would protect the two teeth on either side. So that is what I did. No regrets.

Hi,
What did you do in the end? I have a similar situation as you - wisdom tooth removed a few months ago next to a gap where a tooth was removed years ago. So two gaps. I had the titanium implant screwed in last Friday (4 days ago). The actual process didn’t hurt as I had loads of local anaesthetic. However, I’m regretting it now as the after pain is relentless unless I take paracetamol and ibuprofen regularly. I’m fed up. Tomorrow is day five and I can’t stand the constant tooth ache, I don’t have an infection as no temperature and the swelling is going down.
I wish I’d spent the money on something else. No one is going to see the implant as it’s at the back. My husband tried to persuade me against it. I wish I’d listened to him now …

haha rant over. Dental implants are not without pain.

I had to have a lower back molar extracted - I'd intended to have an implant but the implantologist had me go for a scan (CAT iirc) first to check where the nerve ran. Turned out in my case it was shallow so a normal length post wouldn't work and he didn't recommend shorter ones. So I've got a gap, it's fine so far.

I just forgot about it! I'm used to the gap now and no intention of getting an implant - it doesn't feel necessary or useful and I'd rather go on holiday with the money.

Sorry you are hurting - sounds horrible. Hope it eases up very soon.

Thanks. I’m on day 6 and it still hurts. Not as bad but painful still.
best wishes

I had a bottom molar removed a few weeks ago. I was not in pain before, but it was agony afterwards. It turns out that the roots were fused and tangled with the teeth either side and the bone is also very strong. Apparently, this is very unusual. Two dentists could not completely extract the roots of that tooth, so I have been referred to an oral surgeon to have the remaining root removed under sedation or general anaesthetic. I was toying with the idea of having an implant, but, like you, I have become used to the gap and it is not visible as far as I am aware. I think I will leave well alone. A bridge would not have been a good idea as the teeth either side of the one that was extracted are intact and have never had any fillings, so the last thing any of us wanted was to drill into healthy teeth.