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Apologies in advance for the long post, but I've been depressed and full of anxiety over the past few days due to some recent dental problems.
I'm in my 30s and I've always had pretty good teeth (very straight, no braces, etc). I have had a few cavities over the years but nothing major (no root canals or any other advanced procedures). About 5 or 6 years ago a new dentist advised me to have an older silver filling redone, as some new decay was forming. It was a deep cavity but he refilled it and I thought everything was fine all these years.
I've always kept twice-a-year dental appointments and figured everything was ok with my teeth. A few weeks ago I had a 6-month checkup and my new dentist noticed slight discoloration in my #14 molar. She drilled as far down as she could but said she was still seeing decay so she sent me to an endodontist. The endodontist determined that there was too much decay and recommended the tooth be extracted. Apparently, some of the old silver filling was left in the tooth and decay formed deep within the tooth. Much to my disappointment, I had the tooth extracted and I've been so depressed since having it done.
Now, I'm trying to figure out if I should have an implant or just leave it alone, as it's further back in my mouth and not very noticeable since it's an upper molar (maybe if I yawn). So, my questions are:
1.) Are implants safe? I've read so much the past few days and have found several articles indicating that titanium might not be as safe as dentists have believed all these years (metal leaching, bacteria forming, possibility of long-term corrosion, etc.) From a holistic standpoint, many believe that there could be long-term effects from having a metal implant since the jaw is considered an acupuncture meridian.
I know many people have gone many years without any problems with their titanium implants, but i figure I'm still fairly young I'm trying to think long term.
2.) Is zirconia a better option than titanium? I've encountered quite a few articles that indicate zirconia might be a better option than titanium since zirconia doesn't have the same metallic properties as titanium. I asked my dentist about this and she kind of laughed it off, saying that zirconium IS a metal, which is true -- but from what I read, zirconia is zirconium dioxide which is considered a ceramic material. I also read that zirconia has better biocompatibility than titanium and fights off infection better than titanium as well. In terms of aesthetics, I also like the fact that zirconia implants are white so you don't get the dark shadowing at the gum line like you sometimes do with titanium.
3.) Any problem with doing nothing? I don't love the idea of having a gap in my teeth (even if it isn't very visible). I've taken pretty good care of my teeth over the years so this has been tough to handle. However, if I can't find solid proof that implants are safe, I'll use caution and go without — but I do worry about teeth shifting or my jawline changing, if that's a possibility with leaving a gap. (I already ruled out a bridge as I don't like the idea of damaging other healthy teeth). Will I experience bone loss if I don't get an implant?
Any advice is MUCH appreciated. Like I said, this whole experienced has left me feeling pretty down.
1) Yes, implants are safe if properly placed by a specialist. If you opt to go this way I strongly recommend an oral surgeon as they have additional training in implantology. Ask around as prices may vary quite a bit. General dentists can also place implants but they do not have the same amount of training or expertice an oral surgeon has. Yes, many implants placed by general dentists do fine, but for me there is a reason there are specialists and you don't want to screw around with something like this.
2) Doesn't matter. More concerning is whether or not the doctor wants to do an "immediate load" implant or not. Immediate load implants have a much higher failure rate as they are prone to infection along the walls. If you do opt for that, it is critical to make all followup appointments as they will check for such infection.
3) The longer you want the more bone loss and the greater probability of a failed implant. Yes, they can graft the site but the more grafting material the weaker the implant as it integrates into the natural bone and not the grafted area.
In my humble opinion, if you can afford it I'd get the implant- through an oral surgeon and not immediate load.
Yes have the tooth extracted. And do nothing because it is molar or last tooth in the chain. Implants should be done if a tooth is needed for chewing or if the tooth is readily visible. The assumption is that you have enough bone to allow an implant.
Thank you both for the responses. Just so I'm certain, what exactly is an immediate load implant?
Has anyone had any experience with a zirconia implant? The more I read, the more this seems like a better option since—among other things— it has excellent biological compatibility, high crack resistance, high resistance to corrosion, and doesn't have the metal characteristics of titanium.
Thank you both for the responses. Just so I'm certain, what exactly is an immediate load implant?
There are 2 ways to handle implants.
The tried & trusted way is to graft the area after tooth removal. Let that sit for several months. Then place the implant and place a healing abutment over it and let it sit for several months to ensure the implant integrates well into the natural bone. If all goes well, then place the crown on it.
An immediate load is then the tooth is extracted and grafting material and implant placed at that time. Even though a liner is used (some general dentists forget that part), infection often sets in down the side of the area and it is cleaned out and treated periodically by the doctor- which is why your follow up appointments are critical. If the infection is too great the implant must be removed. If replaced, even with more grafting, the area is now weaker and the long term success rate also decreases. Many doctors are going to these as they are less time for the doctor and they make more money from them.
The tried & trusted way is to graft the area after tooth removal. Let that sit for several months. Then place the implant and place a healing abutment over it and let it sit for several months to ensure the implant integrates well into the natural bone. If all goes well, then place the crown on it.
An immediate load is then the tooth is extracted and grafting material and implant placed at that time. Even though a liner is used (some general dentists forget that part), infection often sets in down the side of the area and it is cleaned out and treated periodically by the doctor- which is why your follow up appointments are critical. If the infection is too great the implant must be removed. If replaced, even with more grafting, the area is now weaker and the long term success rate also decreases. Many doctors are going to these as they are less time for the doctor and they make more money from them.
Thanks for the clarification. I had the tooth extracted so right now the gums are healing. I'm still trying to figure out if I want an implant (really not liking the idea of titanium). A few more questions:
I didn't have any grafting done when I had the tooth extracted. Do you perceive that as being a problem if I would opt for an implant?
Since I didn't have the grafting done during extraction, would I have to go back in to have the grafting done and then wait several months to go back in for implant placement?
How long can I wait to make a decision about the implant (before there's any shifting in the teeth)? I don't want to jump into anything, but I also don't want to create any additional problems.
Thanks for the clarification. I had the tooth extracted so right now the gums are healing. I'm still trying to figure out if I want an implant (really not liking the idea of titanium). A few more questions:
I didn't have any grafting done when I had the tooth extracted. Do you perceive that as being a problem if I would opt for an implant?
Since I didn't have the grafting done during extraction, would I have to go back in to have the grafting done and then wait several months to go back in for implant placement?
How long can I wait to make a decision about the implant (before there's any shifting in the teeth)? I don't want to jump into anything, but I also don't want to create any additional problems.
Thanks again for the info.
You shouldn't have any grafting material placed unless you're having an implant, so that's not an issue.
Probably.
You can wait any length of time, but you are correct in that space will fill in as the teeth around it tilt. You can have the doctor place something there to maintain the space for now while you decide.
the tooth above the pulled one also may cause irration to the gum when it bites down, I had that with a wisdom tooth. irration so they pulled the other one
I am so upset. The dentist told me that the cavity was too large to be filled and that my molar had to be pulled. I was in no pain but she insisted that it must be pulled so I believed her and let her do it. Then I saw the tooth on the tray it looked so white and heathy with just a small red spot on the outside. I said where is the huge cavity? She said that's it there. I was so mad. Now I just read about an overlay which can be done for large cavity. She never told me anything about filling in the empty space with something or teeth shifting or change in face appearance. She kept saying it was a wisdom tooth and that you don't repair it. It wasn't a wisdom it was my bottom molar and I look terrible without it. There is a huge gap. What should I do?
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