Q: Dr. Crapo: Two weeks ago I had a crown fall off. It’s my first molar and when I smile there’s a big hole there. My dentist who told me that decay had gotten under the crown and caused too much decay for him to fix. He started talking implants and I went into shock. When he said bone grafting, I thought I was going to faint. I saw someone else and he thought it could be fixed, so I made an appointment but when he got in he said the tooth had been root canaled and the tooth was not only decayed beyond what the x-rays showed, but the root had cracked so there was no way to fix the tooth. He started talking about implants and grafts and I had a déjà vu. I know grafting bone is done all the time but I can’t get past the idea – even taking bone from another place on me doesn’t go down well with my psyche. I was told that I’d have less bone for an implant without grafting and perhaps not enough for an implant at all. I’m okay now with the implant – can’t it just be put in? I don’t want a bridge because it means cutting down perfectly good teeth – and what if decay gets under them? Can you suggest something? I’m running around with this hole in my smile and I get a bad taste and smell every time I eat or drink something.
A: The counsel you’ve been given is generally right and is the most common way of dealing with a tooth that cannot be saved. The art and science of placing an implant into a fresh extraction socket has been developing rapidly over the past fifteen years. It is now routinely done for single rooted teeth (front of the mouth and bicuspids).
Until recently (last five or six years), placing an implant in a molar socket was not done because of the size of the socket (bigger than existing implants) and the fact that most molars have multiple roots. This made implant success almost impossible. On top of these anatomic problems was the fact that until we knew how to preserve all the bone around molar teeth, the profession experienced failure after failure.
These challenges have now been solved but great patience and skill must guide the extraction to save the bone and a special implant design used so that walls of the socket won’t be lost. This takes greater skill and patience on the operating doctor’s part and is more costly on the patient’s part. The results are excellent. If the bone around your tooth is in good shape and can be preserved, you’re a candidate.