Molars are the most common teeth to have a dental implant. It makes sense because we use the last molars more than any of our teeth for primary chewing.
Why Do Root Canals get Infected?
Most often molars are replaced from a root canal that did not work. The root canal tooth can crack or there is just not enough tooth to hold the crown on so it ends up being extracted. Sometimes a chronic infection is present around the end of the root canal because the crown leaks at the margin edge. This can be inflammation or infection and can change.
There is a skill an art to replacing molars especially the last 2 molars.
The tooth numbers for the molars are #2, #3, #14, #15, #18, #19, #30 and #31. This does not count the wisdom teeth #1, 16, 17, 32.
Last molar dental implants can look really fake and can have problems like bone loss early on. In my practice I have a unique skill set that allows me to replace 90% of the molars that I extract on the same day of the removal!
Immediate Implants For Molars
The time saved by having any immediate same day last molar replacement is usually about 4 months. This technique gets you into a tooth faster than the traditional extract, socket bone graft and wait method. Both methods have their merits and I do both.
If the tooth does have infection it is very important that the infection is cleaned out all the way. Antibiotics are almost always needed at least before the surgery. The infection needs to be physically debrided out of the area and I often treat it with a special antiseptic directly on the bone to clear that out as well
The implant is typically placed in the middle between the roots. Because the implant is purposely smaller than the original tooth, a bone graft almost always needs to be placed into the void created between the implant and the socket walls.
Replacing molars on the same day of extraction requires a much higher degree of skill, experience and judgment. On the lower jaw a nerve is close by. In my practice I use some specialized instrumentation such as piezo electric surgery and osseodensification to make the procedure safe.
The biggest advantage to the same day replacement of the molar is that it saves time, money and yields the best or better result than a delayed replacement. By placing the implant on the same day the bone never gets a chance to shrink by disuse atrophy.
A method that I use to carefully control the shrinkage is by making a custom contoured healing abutment. This is a specialized custom piece to seal off the socket. It holds in the bone graft and help prevent the gum from creating a big dent. It takes extra time during the surgery to make but I find it has a lot of value. It makes the molars look really nice and helps the bone growth substantially. Other times I will use a carbon dioxide laser to shape the gums.
Most patients are sedated for this procedure as removing a molar is difficult. Root canal molars usually come out in many pieces! Just yesterday I took one out in about 23 pieces! Yikes
I hope this helps you decide what to do with your bad molar!
Ramsey A. Amin, D.D.S.
Diplomate of the American Board of Oral Implantology /Implant Dentistry
Fellow-American Academy of Implant Dentistry