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Before You Extract Your Tooth Consider A Dental Implant

The time to consider having a dental implant is before it is ever extracted. As soon as the tooth is extracted the bone will begin to shrink. You can not stop this from happening. For some it happens faster than others, but for most it only takes a couple of months to lose a lot of bone. Generally you can not see the bone loss because it happens under the gum.

If the situation is ideal the tooth can be extracted and an implant placed at the same time or very soon after the extraction.

The old adage “if you don’t use it, you will lose it” applies to the bone in your mouth too! If you stopped using your right arm entirely for a few weeks, it would shrink and become less functional. You may have to undergo physical therapy to regenerate its strength and function.

Once a tooth is extracted, the bone that once surrounded that tooth is no longer stimulated by the force put on it when you chew. Because there is no force or daily stimulation to the bone, it shrinks. It shrinks very quickly and will continue to do so until an implant is placed.

A bridge does not prevent bone loss. A denture or partial accelerates bone loss.

So being evaluated for implants before you ever had an extraction may allow you to prevent the bone loss. By preventing bone loss, you will have saved your self money, reduced the need for a bone or gum graft, and decrease the treatment time considerably. Preventing bone loss also allows for the most esthetic results possible.

To make matters worse, most of the time the other teeth will move and shift after even just one molar is removed.  The teeth will begin to tilt on top of each other  opening up gaps and spaces.

It is unfortunate that too many people wait so long to have the procedure done.Take care of it when it is a small problem!

93 thoughts on “Before You Extract Your Tooth Consider A Dental Implant

  1. I will have an extraction in my lower molar. Is it possible to have a dental implant after a year? Thank you!

  2. Hi Dr. Amin,
    I recently had my left upper molar removed 4 months ago. I want an implant but was told it might be impossible due to the location of my sinsus and my jawline is curved. The Dr. suggested I might have to live with a bridge. Are there cases where an inplant can’t be placed?

    1. It is extremely rare that upper tooth cannot be replaced. Sometimes this can occur on a lower tooth in the most extreme of situations but lifting a sinus can be done very easily. Watch this interactive video on how it is done can see the rationale and learn more about it so you can make a better decision. Good luck with everything

  3. Hi Dr. Amin
    I am 31 years old and still have a baby molar (lower side). My dentist recommends removing it and getting an implant. Apparently there is a silent infection and there is also some bone loss. This molar has no more roots. I can feel some pain on the gum around that molar when I floss with my waterpik. I also have periodontal disease. I am planning to get pregnant soon (within 3 months or so) and my question is – would it be better to start the implant process now and complete it after the baby is born? My worry is that if I become pregnant and the molar is still there the infection could get worse. Would it be a good idea to remove the molar now and then get a temporary cown in the meantime and have the implant after baby is born? Please help, I am so confused.
    Thank you!

    1. You are kind of in a pickle considering you may become pregnant. I tell my patients to keep there baby molars until they become symptomatic. That usually happens some time when you are 30-40 years of age for many people. Of course if it becomes infected during pregnancy, it could create a problem. If it has been symptomatic than it would be better to remove it before becoming pregnant and therefore you would not have to be on antibiotics and have other risk factors during her pregnancy. Remember you will be caring for 2 people soon enough…. Get your sleep while you can!! 😉

  4. Hi Dr Amin
    My crown for #5 will not stay in as there is not enough tooth to hold it. My dentist recommended an implant. I’ve met with the oral surgeon . Had the X-ray and scheduled the extraction. What do you recommend as a cosmetic device to hide the hole in my mouth during the implant process. Thank you

  5. I just had two teeth extracted and plan on having dental implants later this year. As part of the process, the oral surgeon did a bone graft. Anyway, he does not want to meet sooner than 6 months from the extraction date as he feels that is needed for adequate healing.

    I understand his point of view but I am perplexed he didn’t want to consider meeting sooner since every patient is different healing wise.

    I am also concerned about bone loss since I read that it starts as soon as the teeth are extracted and doesn’t stop until implants are completed.

    Before I say something I might regret, I wanted to get the perspective of someone like you as I realize I may be missing something communication wise.

    1. Waiting a full six months is a good idea especially in the upper jaw. Your bone does not heal like your skin wounds. It is much slower. It is best when the bone is more mature. This will lead to long-term success. Every bone graft material and technique is different and of course you are unique. Replacing a tooth should not be a race.

  6. I had some decay under my crown on number 17. The tooth had a root canal. After removing the decay my dentist said that there wasn’t enough of the post left to support a crown and recommended an extraction and implant. He put a temporary cap over the what is left of the tooth. The cap is even with my gum line, like the tooth had been extracted. I want to get an implant to replace the tooth, however I would have to change my insurance plan that would take effect Jan 1st, 2017 to get the implant covered by insurance. Can I wait to have the extraction till January to avoid bone loss?

    1. Yes typically with a tooth that has a root canal it would be fine to wait as long as the bone does not get infected in the meantime.

  7. Due to a bad root canal, I am now forced to extract the tooth due to it broken in three places. My dentist wants me to have a bridge or inplant. Since its my #3 Molar, would it be ok to just leave the hole and spare the expense? Please tell me because I can’t decide and my dentist isn’t answering my questions in a way I understand.Thank you, Karen

    1. The other teeth will move and shift after even just one molar is removed. The teeth will begin to tilt on top of each other opening up gaps and spaces i addition to the bone loss.

  8. Dr sir one of my upper molars are in a really bad condition and needs extraction.
    A. Can an implaant be done on the same day as extraction?
    B. Can an implant be done under local anasthaesia as ina root canal?
    C. What are the long term complications of an implant?
    D. As the implant is done just after extraction would bone grafting be necessary?
    Thank you!!

    1. Each situation varies but in many cases a same day extraction and implant can be done. Sometimes grafts are needed and sometimes they are not.

    1. absolutely! you will likely need some bone grafting reconstruction but it can definitely be done… I do it all the time!

      1. I want to have an implant for the top 2 frontal teeth ….. The nerve was taken out st the time I had a root canal between the two teeth and they became stained . It’s been 9 years now . I wanted to know how much it would cost me to extract and implant two teeth…. Roughly

  9. Hi,
    I’ve been wanting to get 4 teeth removed and get implants but I don’t want to wait. Is it safe to get impmsnts the same day you get your teeth removed or should you wait?

    1. Hello Charlotte

      There is no right answer. It is going to depend tremendously upon how much bone you have available, aesthetic and functional assessment, predictability, the ability to make the implants stable and at least 100 more things. You will very likely need a bone graft to be done simultaneously also.

      Immediate dental implants are more difficult to do from the dentist standpoint. I do these very routinely but case selection is extremely critical. You must absolutely 100% have a preoperative 3-D CBCT scan in order to do this. Find an expert in your area to do this for you. Front teeth are especially critical but immediate implants work very well in this area.

      I routinely do a procedure in my office or I remove all teeth and place dental implant simultaneously for the Prettau dental implant bridge. The computer planning is very important. Here is an example.

      Respectfully,

      Ramsey Amin DDS

  10. Hi Dr. Amin. My upper left molar (#27) has a crack and has to be extracted.
    1) is an implant the best way to go?
    2) What is an alveolar bone preservation-allograft ?
    3) should these procedures be done under local or general anesthesia?

    Thank you for your time and advice.

    1. 1) is an implant the best way to go? —YES–most of the time it is the best answer
      2) What is an alveolar bone preservation-allograft ? —see attached link
      3) should these procedures be done under local or general anesthesia? —it depends on each person but something in the middle called IV moderate sedation is best. General anesthesia is not necessary but IV moderate sedation is extremely beneficial.

  11. Mr. Amin, my #22 baby tooth never fell out and was pulled by my dentist when I was around 18. My permanent tooth never came up and is impacted down in my gum. So as a temporary fix he put bonding in to fill the space until I had the tooth extracted and follow with an implant. My question is, is it entirely necessary to cut out the impacted tooth to have the implant put in? Can my dentist remove the temporary bonding and place the implant?
    Thank you very much for your time.

    1. if the impacted tooth is in the way of placing the dental implant, there are not a lot of other options. I am assuming you have seen a very good orthodontist to evaluate the possibility of pulling your natural impacted tooth into the arch using braces.

      if you haven’t seen her orthodontist, I would suggest you do so before any treatment is done.

  12. Dear Dr Amin,

    I lose my 2 front teeth when i was 14 and now im 22. Im using denture for the past years,is it possible for me to get implants? Cause im losing my confidence talking to others.

    Thanks

    1. YES!!!!!!!!!!!!!!!!!

      You will likely need some type of bone grafting because the teeth have been missing for a few years. Dental implants are likely your best option. Front teeth implants can be very difficult so be sure to find somebody very good to help.

      Good luck,

      Ramsey Amin DDS

  13. Dear Dr Amin,

    when I was around 10-12 years one of my tooth fell off after a untreated cavity , now I am 36 , should I get a new tooth or implant , though I don’t have any problem .

    Thanks

    1. Hi Raji,

      Your question sounds more like a personal life choice question rather than a specific reason question.

      Nature designed is to have 28-32 teeth. We were not designed with this many teeth so that they can be used as “spares.” Every tooth matters. Some teeth matter more than others.

  14. Hi,
    I’m a 46 years old woman and I had a crown on my molar for the last 20 years, obviously rct has been performed on my tooth earlier. Few weeks ago my crown fell off, when i got it checked, my dentist told me that the tooth had fallen off with the crown and now just a little part of the tooth remains which is sharp and is causing irritation and that a crown can not be put on it. I am being advised to get a dental implant or a bridge treatment ASAP. I wanted to know whether i should get an implant or a bridge or can i leave it just like that, because there is no infection in my tooth, or will the teeth that are adjacent to it will shift and cause problems? What should I do please advise.

    1. Without replacing the tooth, your bone will shrink and your other teeth will move.

      I would have to see you to tell you for sure, but a bridge may not be a good choice if the next door teeth are healthy. It would be a shame to grind them down.

      Get the implant. Find a really good dentist who specializes in implant dentistry. Do it right the first time…you will be happy.

  15. Hi,

    I am 27 years old and have two upper front teeth disoriented. Hence considering removal of these teeth and going for implants.

    Please suggest your views on this.

    thanks,

    1. if your teeth are just out of alignment, it would be more appropriate to have orthodontic braces to move them into a better position. Do not just extract the tooth because it is in a bad position…. Move it into the right position if it has good bone around it.

      Ramsey Amin DDS

  16. Hello please i know this does not relate to this article but it is very urgent.Please i have a case whereby a new tooth erupted on a tooth from an upper gum in the front row teeth particularly my canine,my local dentist advised extracting the tooth below because it was already loose,now it’s removed and the erupted one looks fully grown and fills the gap a little bit but shows no sign of it coming down,am scared it’ll look like this forever,making me fearful of smiling and my college mates seeing it,please do help because it is affecting my confidence and am currently 17years old approaching 18years Also my incisor at the right hand side is also crooked,the dentist advised extracting the tooth beside it i.e. a canine,claiming another tooth is still lurking inside the gum,i am not happy with the way my mouth is.Making my smile punctured with so many holes.I urgently need your advice.

    1. You need to see an orthodontist rather than consult with a dental implant specialist.

      It sounds like you have impacted adult teeth that are stuck in your jaw. Oftentimes they can be exposed and pulled into your mouth with braces. This is called surgical uncovery of an on exposed tooth using a closed eruption technique. sometimes the tooth was exposed and it is left exposed with the orthodontic chain attached.

      Again, there yourself in the hands with a very skilled orthodontist so that you can have a beautiful smile and regain your confidence.

      Ramsey Amin DDS

  17. Hi Dr. Amin,
    I left out one question to my comment above….would I be a good candidate for implants if I grind my teeth in my sleep, even though I wear a night guard while sleeping?
    Thanks for your advise,
    sherry

    1. I just replied to you on the other question. Grinding is ok as long as the dentist designs your implant and crown in such a way to hold up to your grinding.

  18. Hi Dr Amin, I cracked my #19 tooth and have been advised to extract it. I am trying to decide which way to go, bridge or implant. I know the implant would probably last my lifetime, but it is also twice the price and the procedure takes so long(I will be without a tooth for at least 8 month). I like the thought of a bridge because I wouldn’t go without a tooth and it’s less expensive. I am a 51 year old, with very healthy teeth(never have had even a single filling). My friends can’t believe at my age why I would go with an implant, they say,’just pull the tooth and forget about it.’ I know however, I want to replace it with something. Do you think a bridge would be the better option for me?

    1. Good things take time!! You are definitely not too old. I just had a 90 year old a few weeks ago have four implants.

      God gave you all those teeth for a reason. Removing one from the system will cause long term problems. You are YOUNG!!!

      A bridge will likely be replaced in 10 years only to have to pay for it again. Go see a really good dental implant dentist. The bridge is a bad option if your next door teeth are healthy.

      Dr. Amin.

      1. Dr. Amin,
        Thank you for the advise…I’m scheduling my appointment with an oral surgeon who believes I can have the extraction and implant on the same day. You’re right, an implant will be better in the long run.
        Thanks again for your opinion,
        sherry

  19. Hi Dr. Amin,

    Is it possible that my jaw receded after having 4 wisdom teeth extracted? I would love to get implants if that is an option.

    Thanks so much,

    Victoria

    1. Hi Victoria,

      If you have a full complement of teeth, removing wisdom teeth would not cause any issue at all. Many people including myself, did not have room for wisdom teeth and they cause a lot of problems. I would not ever consider reimplanting your wisdom teeth.

      Wisdom Teeth Extractions

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

  20. Dear Dr. Amin,
    I had my wisdom tooth no. 17 extracted because it was at an angle and the dentist advised me to extract it because of the gum infection. Ever since i have extracted it, i have been going through severe depression because i think i should have not extracted it. Also, i am unable to rest my teeth comfortable. My bite feels different and always very tense. Due to this i am unable to rest or sleep and having sleep disorders. I asked a couple of implantologists and they said to just leave it and not bother doing an implant. If it is a possibility and no future complications, i would love to have my wisdom tooth replaced. You are based in california. I am in Bahrain. How much would the procedure cost and how long will it take? Please advise.

    Kind regards,

    Sandra

    1. Hi Sandra,

      Replacing your wisdom teeth would not be recommended. If you are missing tooth #18 and 19 which are located right in front of tooth #17, then I would highly suggest replacing those teeth.

      Replacing your wisdom tooth if you’re not missing the molars in front of it, would not likely benefit you whatsoever and would not correct some of the things that you mentioned.

      Also, there is a main nerve located in the wisdom tooth area that would generally be in the way of having an implant placed in that spot. Oftentimes, a short dental implant is required in an area where the nerve is very high or the nerve can be moved, through a process call nerve lateralization.

      Again, you do not need a wisdom tooth replaced…. I am just mentioning these things for teaching purposes.

      I would highly suggest you see orthodontist and try to have your bite corrected that way.

      Wisdom Teeth Extractions
      Short Dental Implants – A Unique Solution to Avoid Nerve Damage
      Nerve Repositioning – Lateralization

      Very Respectfully,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

  21. Dear Dr. Amin,

    I’m very confused. I have been told by my dentist that I need to have #19 extracted because it is fractured and there is an infection. I have had two root canals performed on this tooth. I am considering an implant, and because of the high cost of the procedure, I sought confirmation of the need for extraction from the Endodontist who performed the second root canal, and he also said it must be pulled. Both my dentist and Endodontist say that I must go to an oral surgeon to have the tooth extracted, and neither are addressing the infection with antibiotics. I have read conflicting information regarding just about every aspect of the implant process from getting the tooth pulled through getting the final crown. I’m hoping you can help with a couple of questions:
    1 – Does the infection need to be gone prior to extraction? (I have read that if it is not, then it could spread to other parts of the body when the tooth is pulled) Also, my dentist says the infection is causing bone loss but also indicated that I don’t need to have the tooth pulled immediately (though I do have some discomfort from the infection). Should I insist on antibiotic treatment prior to having the tooth extracted?
    2 – Should I have the implant done immediately after extraction? I have read that it is best to have the implant done when the tooth is extracted to prevent bone loss, because once the tooth is gone, bone loss is very rapid and waiting will result in having to have bone grafting done. However, I have also read that it’s not recommended to have it done at the same time, and that it’s best to wait 4-6 months, after extraction, to allow the bone to heal and to be sure there is no infection present before having the implant done.
    I appreciate any advice you can give.

    1. For the great majority of molar teeth, delayed rather than immediate placement typically works best. In some situations placing the implant on the same day and a molar is possible and in fact helpful, but for the vast majority, extraction with a socket bone graft will likely be her best course. This is going to depend on your preoperative x-rays and the condition of this infection.

      My guess is this term infection is being used loosely. The infection you likely have is a chronic infection and not in acute infection where your face is swollen. Yes, some infections can spread all the way into the chest especially if it is a lower wisdom tooth which has an easy pathway to do so. For most tooth #19, as long as you’re not symptomatic, the infection does not need to be absent to remove the tooth.

      Rather than focusing on a particular specialist such as an oral surgeon, find the best dentist that is a good fit for you. I would suggest finding a credentialed dental implant specialist that can do the entire procedure from start to finish. You would not need to see multiple different providers. This will end up saving a money and likely end up with a better result. The same can be done with an excellent team approach though.
      You are hearing different stories because each individual patient and situation is extremely different. You will not fine the best answer on the Internet , you need to be evaluated in person . Every single day in my private practice in Burbank I treat some cases as extraction-implant-bone graft all at the same time in some cases require each one of those stages to be spread out over months. The goal is for you to have a fantastic replacement tooth done in a very predictable manner.

      Very respectfully,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

  22. I have a ‘wing bridge’ next to my two front teeth which is failing and I have to decided on implant or denture. (unfortunately my dentist cannot do implants) If I go for implant, I presume it would mean 2 implants? Also how would I be able to cover the gap until the implants have settled in?

    1. Hello James,

      It sounds like you have what is called a “Maryland bridge.”
      Depending on the spacing, usually 2 implants are needed. Occasionally will use a single implant to support to teeth in situations where the implants may be too close to each other. Implants that are too close to each other in the front of the mouth almost always yield a poor aesthetic result. Ideally there is 3-4 mm between each implant.

      Front Teeth Dental Implant Samples

      Dental Implants – How long does it take

      During the time that the dental implants are healing, usually the Maryland bridge can be re-bonded back in place or another type of easily removable temporary can be made. There is no reason for you to be without teeth during this process.

      I hope this helps you,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, California

  23. Hi, I am 34 years old. I have been advised for 6 sessions (for 6 weeks) of physical therapy due to mild disc bulge at the back. I am on my first session now. At the same time i am planning to extract #13 and #4 as this been advised before, due to the plan of having braces. Second i am planning to get first pregnancy after 5-6 months.

    Please advice if this is fine to get teeth extraction and having braces after a week of extraction and currently on the session of physical therapy, And planning of first pregnancy after 5-6 months?

    Thank you very much.

    1. Hello Ingrid,

      Braces can be done while you are pregnant but extractions cannot be. That being said, be sure to plan for the extraction sockets to be bone grafted so that they do not shrink during the time you are pregnant and then probably nursing afterwards. The last thing he want to do is end up having severe bone loss that you would have to rebuild after having your baby.

      I hope this helps you,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, California

  24. Hi, i am 34 years old i have been advised of 6 sessions of physical therapy due to mild disc bulge at the back. I am on my first session. And i am planning to remove # 5 both upper left and right, then have for braces. And second, i am also planning to get pregnant after 6 months. With this condition, is it okay for the 2 teeth extraction and go for braces after a week?

    Thank you

    1. Hello Ingrid,

      Braces can be done while you are pregnant but extractions cannot be. That being said, be sure to plan for the extraction sockets to be bone grafted so that they do not shrink during the time you are pregnant and then probably nursing afterwards. The last thing he want to do is end up having severe bone loss that you would have to rebuild after having your baby.

      Socket Bone Grafting….Do I Need It for My Dental Implant? Ramsey Amin DDS Reviews

      I hope this helps you,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, California

  25. My wife had lower wisdom tooth removed and a implant done at the same time everything was ok for 5 days and then her side cheek started to swell and come to find out the surgery site got all infected and went to her sinus now she has to have surgery to fix this problem should the dentist waited for the wisdom tooth extraction to heal your thoughts

    1. Hi Santo,

      It is extremely common and safe to remove wisdom teeth and place implants at the same time. Over the last 15 years I have routinely extracted teeth in place dental implants at the same time. It is safe and predictable. Typically these procedures have a postoperative antibiotic for 7-10 days to help reduce the chance of getting an infection but that does not guarantee that you will not get one.

      Hang in there, I’m sure things will resolve quickly.

      Burbank Dental Implant Specialist: Review of Immediate Dental Implant Considerations

      “Sterile” Dental/Bone Graft Implant Surgery… Is It Possible?

      Respectfully,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, California

  26. I understand that having a tooth implant while pregnant is not generally advisable, but what if one had a tooth implant that came loose and fell out during pregnancy (the entire implant from the bone). At 6 weeks pregnant would it be more advisable to wait until after the pregnancy to do the replacement implant and have to deal with the bone lose and teeth shifting, or would it be better to put the new implant in asap?
    Thank you

    1. Hi Mitch,

      Nothing is more important than that little baby! Replacement of this tooth will have to wait until pregnancy and most of nursing is complete.

      Periodontal Disease and Pregnancy

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, California

  27. Dear Dr Amin,

    I’ve had two failed fillings on a lower left molar. I went to see an endodontist this week with the hope of saving the tooth. Unfortunately I’ve been told it is likely that the vertical cracks have reached down too far and I will need to have this tooth extracted. My corresponding molar on the other side was extracted over ten years ago, which has led to the tooth moving and dipping downwards. I dont want this to happen on the left side. I am also trying to become pregnant and concerned about getting an implant at this time. The tooth is due to be assessed and probably extracted next week and I would appreciate any advice you could give to me. I wondered if the effects of pregnancy on teeth made it harder for the bone to fuse with an implant?
    Many thanks,
    Emma

    1. Hello Emma,

      Be sure to enter your pregnancy with dental health. Once you become pregnant, it is very difficult and often contraindicated to do any treatment on you whatsoever. Pregnancy is a beautiful thing and will not be a problem with your healing should you decide to do treatment before you become pregnant.

      I would suggest you have an extraction of the tooth with a same day socket bone graft. The purpose of this is to preserve your bone from tipping in. Because it may be 1-3 years before you replace this tooth it is critically important that the dentists chooses a bone graft material that does not dissolve away too quickly. Some bone materials dissolve so quickly that by the time you have the implant done, the bone graft itself will be shrinking.

      Be sure to discuss this with a very skilled dentist that fully understands the time that bone grafts resorb due to disuse atrophy. My suggestion would be to use a combination of human tissue bone and cow bone covered with a collagen membrane. The percentage of each bone needs to be discussed with you also. You can also turbo charge are healing using your own growth factors such as PRP/PRF/PDGF that should be taken and made from your own bloodstream on the day of your procedure.

      Socket Bone Grafting….Do I Need It for My Dental Implant? Ramsey Amin DDS Reviews

      Very respectfully,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, California

  28. Dear Dr Amin,

    I used to live nearby your place; need your advice – I made a mistake 8 years ago when my #14 was damaged. It was extracted and the dentist put a bridge (wish I knew you at that time). 8 months ago, the #15 was bad so we have to cut the bridge and remove it. This time I decide to do implant on both #14 and #15. So I do the bone grafting in the area (it costs a lot of $$) and getting ready for two implants. Two weeks ago, the dentist found out that my #16 (the wisdom tooth) is bad; so he only did the implant on #14 and leave me two options – To pull the #16 and do implant on #15; or to do the root canal on #16 and have two big crowns to cover #14 (implant) and # 16 (wisdom tooth with root canal). What should I do? I want to keep the original tooth (My #16 is still good but 30 degree toward to #15) but is afraid of that the position of original #15 is empty and may have bone loss again. Which option will have better long term effect?
    Your advice is highly appreciated! Jane

    1. Hello Jane,

      Wisdom teeth rarely help any type of dental restoration. If the wisdom tooth is off axis and facing 30° forward your best option is to remove it. Dental implants to be placed for tooth #14 and 15 with a likely internal or lateral window sinus bone graft if the sinuses are in the way. You definitely do not want to connect a natural tooth to the dental implant in the #14 position. The best long-term prognosis is to have connected implant crowns for tooth #14 and 15 to help absorb the heavy bite force of this area which generally has soft bone. The wider and longer the implants the better for this particular area of the mouth.

      Sinus Lift Bone Graft

      Good luck and yes I wish you did live near me again!

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      1. Thank you so much for your reply. I’ll definitely follow your advice. Yes, I may move back to CA. It’s on my list of my retirement plan.

  29. Dear Dr Amin
    My mother had a bad case of perodontitis, and her doctor extracted a number of teeth saying they were compromised. He then said she had to wait 6-12 months to enable the bones to recover and re-assess the situation. From what i read here it was a huge mistake, since her gums and bones actually retracted!!
    The doctor now wants to put an overdenture on the upper side since he says that bone mass is too small to implant the needed support for a fixed bridge… She is very sad and we do not know what to do now. He face has changed and she aged 20 years from when she started 2 years ago. What would you recomment to rebuild her face structure? thank you for your advise

    1. I’m sorry to hear about your mother. It is normal for the muscles of the face to become flabby after removal of the teeth. The face go through a major change because the muscles are not being used like they use to when she had teeth.

      Hi Rupe,

      Dentures are notorious for causing permanent facial change. I have had several patients noticed that after having fixed dental implants with the Prettau bridge go through substantial positive facial changes.

      Over dentures are not as good as fixed porcelain Bridges. If implants can be placed on the same day of extraction with the same degree of predictability and safety, then it is often the treatment of choice.

      Of course, saving your own teeth is always best if they can be saved.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

  30. Hi there,
    I have a molar that needs to come out (my lower jaw, right side… it’s almost completely gone and now has absessed. I’m taking antibiotics.) and I was reccomended an implant. I can afford the extraction (without insurance as I have none), but I cannot afford the implant ($2000 split into 2 month payments..). How long can I wait after getting the molar removed to get the implant?
    I recently went in to get my mouth looked at and the dentist said I indeed need the implant for the reasons this article mentioned.
    I’m very worried about the absess as well. I read that dentists can’t remove the tooth until after it’s gone. The absess is on the side of the tooth…

    1. Hello Cindy,

      In general, some lower molar teeth should not be extracted if they are really infected and you are swollen with fever. That can lead to a situation where the infection can spread to your neck and downward into your chest.

      In general waiting 3 to 6 months after having a tooth extracted is the ideal time to be evaluated for dental implant. After that period of time, the bone really begins to shrink. Preventing bone shrinkage by doing the implant earlier, will help reduce your costs, make the procedure more simple, likely avoid the need for a bone graft, and overall have less pain and potential complications.

      I would highly suggest you get this done soon. Do not wait. It only gets worse.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, California

  31. I had #11 extracted on Thursday (6 days ago). I would love to have an implant, but cost is a monster issue. How much do implants cost? I am a single mother, disabled and on a fixed income. I have dental insurance, but not much. If I can’t afford an implant what would be your next suggestion. Thank you!

    1. Hi Chrissy,

      #11 is the upper left canine if you are using the American tooth numbering system. This tooth is a very important tooth! It is the cornerstone of your whole mouth! It is a difficult dental implant to replace because that area is supposed to have a bulge of extra bone called the canine eminence. It usually requires a custom angulated dental implant abutment and full ceramic tooth.
      Cost will vary depending on your doctor’s skill and experience. I would suggest someone in your area who is a diplomate of the ABOI as I am. When replacing body parts, you really should seek out the best!

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

  32. Hi, I am currently 12 weeks pregnant. I’ve always had issues with my tooth #10. I’ve had a root canal and 2 apicoectomy procedures done to this tooth, but they did not work. Now that I’m pregnant and my hormone is causing that teeth to swell up again everyday. No pain though. I’m afraid for my baby.
    I want to do an extraction but I don’t know if it’s safe to also prep for an implant at the same time of the removal. When is the best time to do the extrationa and should I just extract it for now and get an implant after I give birth?
    Please advise. Thank you so much!!

    1. Hi Sandy,

      The timing is not good. The second trimester is reserved for emergency only procedures. I would not place an implant while you were pregnant, but you need to manage the infection of the root canal. Get in the hands of a skilled dentist asap!
      Here is some general info:

      http://www.burbankdentalimplants.com/periodontal-disease-and-pregnancy/

      Good Luck and Be Safe! Congrats on your baby! 🙂

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

  33. Hello Dr. Amin,
    I currently have 2 failed rcts in tooth 4 & 12 and am considering braces because of the crowding on the top and bottom. I have been told that I would be treated as an extraction case. The teeth that were recommended to have extracted are 4 & 12 with the teeth that are aligned with those on the bottom. I also have the two bottom wisdom teeth in place and those were also recommended for extraction. I need some advice because getting 6 teeth extracted scares me a bit. Should I get bridges and then get the braces or just have the teeth extracted?

    1. Hi Jen,

      Definitely don’t get bridges. Have another orthodontist look at you. Many orthodontists now use temporary dental implants to move teeth better than the old days.

      The wisdom should probably go, but maybe you can keep the others.

      Your bite is going to dictate all of this.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

  34. Your site is well put together is most informative. Many sites do not give you proper information to compare with … I thank you for showing and explaining the difference of dentures and implants thank you

    1. Hi Darl,

      Thank you for your very kind words. I am a big believer in having all the facts. Having a full implant bridge is a big decision. To this day, I haven’t had a patient ever regret it. It is like having your original healthy teeth again.

      😉
      Dr. Amin.

  35. Dr. Amin, I would like to know what happens to the opposing tooth in the other jaw if I extract a molar? Is it true I’ll loose or I’ll need to remove the opposite tooth in a long term?

  36. Dr. Amin, i previously posted about the costs of acrylic vs porcelain permanent dentures – upper and lower: 16,000 for acrylic vs 25000 for porcelain. To answer your reply, this does not include the initial surgical procedure which consisted of bone graft and sinus lift: 7 titanium rods on top and 5 on the bottom: cost for this procedure – approx 19,000. dollars

  37. Hi Ray,
    I would go with your doctors recommendations. Without seeing you, I can’t offer that specific of advice.
    You are welcome to come to my office if you live here.
    Respectfully,
    Ramsey Amin, DDS

  38. Hi Albina,
    Have the implant either before or after pregnancy. Do not have it during pregnacy.
    The implant itself poses no risk to the child, but there is no need to have a surgery while you are pregnant.
    Does this help?
    Dr. Amin

  39. Hi. I’m 31 years old, and want to get pregnant for 1st time, but one of my teeth was root canal and now it is broken infected so my dentist suggests me to extract that tooth and use an implant as soon as possible!!! But as I know dental implant is very dangerous for pregnancy.
    I would like to know that is it possible to get pregnant after a dental implant and is not it risky for child health?

  40. I would appreciate your expert advice. I am 45 yr old male and can handle the truth. After 3 xrays and examination my dentist suspects that teeth #10 and #11 are fractured and also presenting with infection. I was referred to an endondist for a second opinion and am taking antibiotic and pain medicine. I have pain at the crown of my head, moderate eye pressure, sharp moments of pain to the ear, sore jaw, swollen face and redness. Truthfully speaking and assuming the worst scenario, am I better off healthwise and financially to have them both extracted and replaced with implants? Or should I go along with recommended RCTs, crowns, etc?

  41. Hi Barbara,
    You want to have your gums in excellent condition BEFORE you put braces on. Make sure the bone loss is stabilized before braces. A deep cleaning is the first step.
    I suspect you have had gum disease for many years unbeknownst to you. It is painless until the advanced stages. Be sure to have your teeth cleaned every 3-4 months by someone well versed in gum disease management.
    Good luck!
    Dr. Ramsey Amin

  42. Dear Dr Amin,
    I wonder whether you could help me. I am absolutely shocked by the news that I have horizontal bone atrophy. I was just about to have braces put up.
    I have just started reading up on this topic on the internet to familiarise myself and I came across your excellent website. Would you advise against having braces if one has bone atrophy? Does it accelerate the bone loss? I am a 34 year female who always looked after her teeth and never had any gum disease. What could have caused the start of the bone loss at such an early age?
    Your response would be much appreciated.
    Many thanks.
    Kind regards,
    Barbara

  43. Hi Max,
    It is unfortunate that most people, including dentists don’t get this information out to the public.
    Keeping a tooth until it falls out is not a good option anymore.
    Dental implants are very straightforward when there is no bone loss. Keeping a bad tooth only worsens the prognosis and increases the price and risk.

  44. Hi Dr Amin,
    This is a very good article and does highlight the need of faster follow up dental treatment, namely implants following extraction.
    You’ve got an informative blog – we’ll keep following it.

  45. You have a very informative blog. I didn’t know that if the tooth is extracted the bone will begin to shrink.

  46. I also find that people don’t floss under bridges, but flossing around a single impant tooth is very easy!

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About Ramsey A. Amin, DDS

Dr. Ramsey Amin has extensive experience in surgical and restorative implant dentistry. As one of only less than 400 Diplomates of the American Board of Oral Implantology/ Implant Dentistry (ABOI/ID) he is considered an expert, and board-certified in dental implants. He is a former instructor at the UCLA School of Dentistry.