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Last Molar Extracted… Do I Need A Dental Implant?

My last molar was extracted… Do I need a dental implant? I have received this comment/questions so many times that I decided to write a quick post about it!

Missing Lower Second Molar –No bite support on Upper Molar after lower was lost

Last Molars Are Not Always Needed

To be clear typically our last molar that shows in the mouth is our second molar. This is under the assumption that your wisdom tooth or “third molar” was extracted or is still under the gums.

The second molars are directly in line with our main chewing muscle called the masseter. These molar teeth tend to break because it is in an area of high-power. I even had my own second molar break a few years ago! 

So do you need to replace this tooth? If it is the bottom molar and you still have the upper opposing molar than I would typically say yes. The reason for it is if you do not replace the bottom molar, the upper opposing second molar will begin to over erupt out of its socket trying to reach its old partner that got extracted.

Teeth need contact with one another.

Without contact with another tooth our teeth tend to drift. It will drift enough to where you will and up-biting your cheek and gum and can also become an interference in your bite causing “TMJ” which is really temporomandibular jaw joint problems (TMD.)

If it is the upper molar that got removed the rules are a little bit different. Some people can get away without replacing the upper second molar. This is because most people have a class I bite and the molar that is left behind on the bottom usually still has something to bite against. This is because the upper and lower molars to not aligned perfectly on top of each other. They tend to be a half tooth off. So some teeth are only biting on half of the tooth…. which is often all we need.

The lower molars to not over erupt as commonly as the upper molars do when the opposing tooth is removed. Sometimes the bone over-erupts as well causing a much more serious problem.

Upper Vs. Lower Molar Implants

Please keep in mind that not all molars need a socket bone graft and then the implant a few months later.  A more advanced procedure is to have implant, bone graft and extraction on the same day.

This particular patient is missing a second molar on the bottom jaw. You can see from the side view that nothing supports the upper molar. If he takes it does not replace it, the upper tooth will eventually be lost. He elected to have me place an implant for him.

Please note that in the United States versus internationally we number teeth differently.

In the United States the second molars are numbered: 2, 15, 18, 31

These correspond to the international numbers of 18, 28, 38 and 48.

It often becomes confusing to answer questions about specific tooth numbers unless you are very specific with where you live!

Ideally, most second molars should be replaced. Nature gave you 8 molars in total. Make sure you are assessed carefully for your bite to see if you really need them are not. Most of my full mouth FULL implant reconstructions do not have second molar replacement. Why? Even though these are important teeth as long as we have the molar just in front of it… The first molar… You can have a stable healthy mouth for a very long time. But remember this is carefully planned this way.

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

277 thoughts on “Last Molar Extracted… Do I Need A Dental Implant?

  1. I am 45 years old. I’ve never had straight teeth, or healthy teeth. Several root canals and crowns as an adult.
    I had a root canal in #18 two decades ago, and now I have a cavity. Dentist wants to remove the old crown, handle the cavity, and replace the crown. Because of the age of the crown, he can’t predict the extent of the cavity.
    I think I want to have it extracted instead. Opinions?

    1. If your tooth is predictably savable and it is best to keep it. Ask your dentist what would he or she due in their own mouth in your particular situation. That might help clarify the best option.

  2. Hello Docter,
    Thanks a million for your expert advice.
    My wisdom teeth are in the sleeping position. It’s affected the tooth #31 next to it. Should I get both of them extracted or is there any chance to save #31 with a crown? Should I opt for root canal or implant if #31 will affect my chewing?
    Thanks in advance

  3. Hi Doctor. So #31 is decayed and being removed next Monday with a bone graft, and I still have #18. An implant is way out of my price range. So it’s either a partial or nothing. Which option would be best?

    1. If you are not going to have an implant, not sure doing a graft is really needed. I would pass on it. Most of the time I place the implant AT THE SAME time as the extraction.

  4. Hello!
    Had TMJ surgery for symmetry back in 1995. I’m 41 now and molar #2 with an old filling has begun to ache. Was sent to endo who recommended root canal. I got second opinion from biological dentist and she said root canal there may have high chance to fail because of condition of tooth. Recommended extraction. I do not want a change in symmetry. My bite is not perfect. I guess my question is do I root canal or extract and does my precious surgery make any impact on outcomes. Stressed a bit over the decision. Also, is extraction/implanting painful? I have developed a great bit of anxiety with all the work I’ve had.

  5. Hi Doctor,

    I had a question I am getting my tooth#31 removed Oct 20 because it got infected badly. So It can’t be saved. I wanted to ask first for a tooth#31 removal is it painful?

    Second Question: Will I need a implant ? Will I need it right away after my tooth removal? What happens if I don’t do a implant? Is it dangerous?

    Thank you

  6. Hi Doc, I had to get my 31 extracted due to infection, surprisingly though the dentist never prescribed any antibiotic treatment ever. Following extraction i was advised to have an implant with bone graft and membrane etc etc. Following placement of implant i could never bite without pain and could never use that side for chewing & eating food (managed with one side). Now suddenly after 1 yr of literal no usage the implanted teeth is wiggly and in lots of pain. Since i could not chew any more had no option but to extract the implant out. I dont want to go through the unnecessary cost, time and pain of having to implant again, do i really need to put a bone graft? I am happy to leave without this second molar.

    1. Antibiotics are not always necessary.

      It sounds like your bite was never ideal and perfect on the implant. If the bite is too heavy especially on a last molar, the implant will fail miserably. You were not the first 1 I have consulted about this. If you are not going to have another implant that you do not need a bone graft. You can leave the second molar as an empty space but keep in mind that once 31 is gone the upper molar #2 is going to start moving downwards. Maybe the space was too small to begin with for implant.

      Dental implants are a very specialized procedure and I find way too many dentist without a lot of experience placing in restoring implants. If you do decide to do another one, due to your due diligence and find a very experienced implant specialist.

      Sorry that dentistry has that you down ;-( Most people that have an implant will have it for a very long time with a very high success rate

      1. Thanks Doc for your valuable and objective guidance. 😃 I sure will do some diligence once I decide to go for second round.

  7. Hi Dr,

    First I want to say thank you for this article and for after all this time still replying to the comments.

    I’m 33 years old and I hadn’t been to the dentist in several years due to phobia, depression & alcoholism. I finally got the nerve & went to the dentist to try to get my life back on track. Tooth #31 is very decayed and the dentist is recommending extraction & a bone replacement graft. I asked him if I needed an implant, he said we could talk about it in the future but he thought it was best to remove the tooth/ infection & let it heal first before doing the implant. Is there any issue with this ?

    #30 also has an infection and the dentist said we may be able to save it with a root canal & crown lengthing. Are crown lengthing a long term solution or am I just buying time?

    1. No issue with not having any immediate implant for a molar. It is more important for front tooth to have immediate replacement although it does save some money and time to have the molar replaced at the same time it is extracted. Probably 80% of the molars I treat are immediate placement

      #30 may be eventually an implant but without seeing you and your x-ray would be hard to tell. This is also very technique based. Many teeth do quite well as long as you do your part at home. It sounds like you got a handle on alcoholism which really causes a lot of dental disease as well.

      Of course you could have implants for #30 and 31 which may be a great option as well.

  8. Still have 1 wisdom tooth – 32 – but need to have 31 taken out due to a very deep large cavity – will this cause a problem…. without having an implant. I do have crowding in the front lower – would love if this gave me extra room

    1. It will not really give you extra room in the upper molar #2 is likely going to over erupted. I am assuming that you are 30 years of age or under.

  9. In the past few months, my upper molars (US 2 and 15) have both been broken and there is not much of the tooth remaining. It occasionally hurts after eating and/or brushing my teeth but it’s never been really painful. All of my other teeth are perfectly in tact. If I end up getting the upper molars extracted, is an implant necessary? I’m 37 years old.

    1. From a gender standpoint some females show all the way back to #2 and 15 when they smile. Dental implants are elective so you do not have to do anything.

      Please keep in mind that although dental implants are the very best tooth replacement they are not permanent. Nothing is really permanent including fillings, crowns, bridges etc. They do last a long time though especially when done right the first time!

  10. Hello Dr.
    I am 53, and just had #15 extracted due to deep crack in tooth, and underneath infection. (Upper left last molar)
    My wisdom tooth next to it was already extracted last year due to cavity.
    Now I need to decide soon if I need an implant to replace #15 or not.

    Can you please tell what is the life of an implant?
    (Would I need to do another replacement down the road)

    1. Please keep in mind that although dental implants are the very best tooth replacement they are not permanent. Nothing is really permanent including fillings, crowns, bridges etc. They do last a long time though especially when done right the first time!

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

  11. Hi.
    I need to have #14 extracted. I’m missing #19 and #31 and #15 has a crown. If I have #14 extracted will I need to get an implant or will it be fine without one. My extractions are over 10 years old.

    1. You should! The most important molar numbers are #3, #14, #19 and #30! Even though you will be fine in the short-term, as you age your jaw will collapse and change. Nature gives us many molars for reason!


      Stay safe during COVID 19

  12. Hello,
    My #32 (US) cracked and from the message above I understand I should get an implant otherwise the upper molar might shift. How long can I wait before extracting the tooth? I’m currently not eating with my R side.

  13. Hello,
    I have had teeth 18 and 30 extracted due to damage. I am 22 years old. Tooth 18 has been gone now for quite a few years and hasn’t bothered me at all, but I am noticing the teeth behind it are slowly shifting forward ( I have both my bottom wisdom teeth). I just recently had tooth 30 removed a few days ago. I was wondering, in your opinion, what the best replacement option would be? I am wondering if there are less invasive options than an implant, maybe a partial denture or flipper tooth? I just really do not want to go through an extensive surgery. Thanks for the help!

    1. Your procedure is not likely an “extensive surgery.” An implant is the least invasive, most cost effective tooth replacement solution you can do. Everything else is much more aggressive like a bridge where your teeth are ground down. The sooner the better especially at your young age your teeth will shift very quickly!

  14. Hello! I am 44 and I had #15 recently extracted and decided not to do bone grafting/socket restoration for an implant. I’m having a hard time adjusting to the missing tooth – feels like the adjacent tooth (#14) is poking in my cheek or tongue at times and I catch myself “sucking on it” a lot? Sorry, sounds gross – is this just something my mouth will get used to or is there anything outside of an implant I can get to replace the tooth? I understand that a flipper is not an option for that tooth. Thanks!

    1. Not too many options in this situation except for an implant. You can still have it done even though you did not do the graft! Stay safe!

  15. This is an amazing service you offer us. Thank you from my heart.
    I’m 58 years old. My #14 fell off. My dentist put an implant to replace it and that fell off after 3 months. The gums were not ready. He said that it in general, was not necessary to replace #14 (true?) and we decided not to put one. A year later, it seems that #15 has shifted diagonally and is taking some of the previous space of #14. FYI, I had braces when I was a kid and 4 teeth were extracted. Thank you

  16. Hi Dr. – I so appreciate your willingness to answer questions.
    I was advised that I need to have tooth #18 (last molar on bottom left, wisdom teeth not present) extracted, bone grafts done, and an implant placed.
    I had a root canal done on this same tooth 2.5 years ago which went badly wrong – I ended up with an abscess and Ludwig’s Angina, and spent two days hospitalized (away from my newborn). Once it healed, the crown was placed – but within a year there was a cavity underneath the crown and they did the filling by drilling through the crown (told this is common practice).
    I went in today because that tooth felt sharp and I figured either the crown had chipped or the filling was loose. While getting that checked, dentist says he believes (but cannot be entirely sure without a CT) that the tooth beneath the crown is cracked, and that there is continued loss of (pulp? bone? I wasn’t entirely clear) beneath the crown. Said a second root canal could be tried, but probably easier/better to just extract, do bone graft, and replace w/ implant- and pushed to do it TOMORROW, then handed me a credit card application at the reception desk to make that possible, since my insurance company considers implants cosmetic.
    I am fine with extracting – sort of wish I’d done that from the getgo honestly! – but I am absolutely terrified of further invasive procedures, and the hard sell approach makes my anxiety even worse.

    1. Ludwig’s Angina!!!!!! That tooth should have been extracted if it caused that type of an infection. That is SERIOUS! Implant would be a much better option in your case! Stay safe!

  17. Dr., I am looking for your opinion. I just had #15 extracted due to an infection and bone decay around the tooth. Dentist put a collagen graft there right after the extraction. Two days later and I feel #14 has a tiny bit of movement.
    Will the collagen be absorbed and harden to maybe allow an implant if i choose and will #14 now lack support and eventually also be a loss? Or should there have been a different route?
    I appreciate any feedback.

    1. Great Question! Sometimes the adjacent tooth may get a little sore in the healing process. This should be gone in 10 days. #14 should be fine!

  18. Dear Dr,

    I have crowns on the second molars both upper and bottom. The upper tooth also has root canal and can’t really hold a crown. It needs to be extracted at some point because there’s not so much tooth left. The bottom one is doing ok. My question is will the bottom one grow out of socket if it has a crown on? Thanks

  19. Have deep crack through bicuspid on upper right. Dentist said cracked through cannot do a root canal. Needs to be extracted. He said I should get an implant. Do I need to get implant? Said it will be around $4,000. I don’t have insurance and am 70 years old. Can I just have the tooth extracted? Do I need to get an implant? My teeth are healthy, never had any removed only 4 fillings. Please let me know. Thank you for your time and help. It is greatly appreciated!

    1. Implants are elective procedures. Of course you can go without a tooth but your oral health is better with that tooth. The bicuspids are very important teeth. You may end up cracking other teeth because you do not replace this one. Your bite will be out of balance.

  20. Hi Dr. Amin,
    Thank you so much for your insightful article. My tooth 27 (international numbering) was extracted last year due to decay, and a root canal was done to tooth 26 right before pandemic. Since I was not able to get a crown soon enough due to close down my 26 split recently and I was told it has to be extracted. I am 24. Do I have to get an implant for it or is it too risky to just leave it empty? Thank you very much in advance!

  21. Will having a top molar extracted change my appearance? I need my last top right molar extracted. Do you advise an implant?
    Thank you so much!!!

  22. This is such an informative forum. I would love to know your opinion on getting an implant (or not) after extraction of tooth 15. I have had all 4 of my wisdom teeth removed, so it is the last tooth on that top side. I have an x-ray of the top and bottom teeth on that side of my mouth and how they meet. I have the photo here:

    It is the tooth behind the implant. Do you see the decay? I have been told it will either need root canal + crown lengthening + crown or extraction and the of course extraction + implant. Advice?

    Thanks in advance!

        1. Looks like internal resorbtion. See a root canal specialist first. It is possible this tooth can be saved. The x-rays are little bit grainy though

  23. Hello, Doctor Ramsey! I’m 28 years old and only have my #31 molar left. And my #32 molar is up for extraction. Do I need implants for #28, #29 and #30? But it would need bone grafting since it has been a decade since they were extracted. I am afraid of possible late implant problems. I was wondering if you would also recommend dentures instead? Thank you

    1. You would probably be better off extracting the wisdom tooth #32. Then you could have two implants. 1 for #28 and 1 for #30. You can make a 3 tooth bridge from #28-30 making 29 a pontic. This will work great. It will save you some money and still have a very good long lasting result. You will probably need some form of bone widening. This is a great procedure to quickly add bone at a low cost that will last for a long time since it is all your own!

  24. Hello, Doctor! First of all, this has been a very informative thread. I was hoping you could answer a query which I hope would also be beneficial to others.

    I am 29 years old. On the right side, all of my teeth are intact except for #19 (lower right)

    On the left, all upper teeth are intact, BUT as for the LOWER LEFT, #30, #29 and #28 have long been extracted (about a decade ago).

    #32 is up for extraction. Should I get implants or bone graft for #32 to prevent (and please correct me if i am wrong) super eruption of #1 and to prevent future problems from loss of #32?

    Bone graft and implant was also suggested for #30, #29 and #28 (extracted about a decade ago). Should I get the bone graft and implant for the three molars or would dentures do? I can feel my left cheek caving in in the place of the three absent molars and was told that my lip would droop eventually because of the non-use and non-development of muscles on one side, especially considering that my sole remaining molar is #31.

    I have been in a constant state of anxiety over this and would really appreciate your input. Thank you and more power!

    1. You would probably be better off extracting the wisdom tooth #1 and the wisdom tooth #32. Then you could have two implants. 1 for #28 and 1 for #30. You can make a 3 tooth bridge from #28-30 making 29 a pontic. This will work great. It will save you some money and still have a very good long lasting result. You will probably need some form of bone widening. This is a great procedure to quickly add bone at a low cost that will last for a long time since it is all your own!

      1. Hello Doctor. Im wondering what is the timeframe for a dental implant after extraction? I only have two molars on the left side of mouth. 14 was removed due to decay/inability to afford a root canal in 2018, 16 was removed due to impaction in 2017. 17 and 18 were removed due to 17 being untreateable and full bony impaction of 18 very recently. Ive disscused implantation in the socket of 14 with a specialist. I just don’t have 4000 to spend on that right now. What is the risk in waiting longer? The margins of socket 14 have maintained their margins quite nicely over the past 2.5 years and teeth haven t moved Would waiting for another 2 years do irreversible damage. Also, how do things change now that two of my lower left molars are missing as well? PS the specialist mentioned something about a sinus lift but he’s not sure if they’ll need to do one.

        1. Things are likely already moving you just can not see it. Typically I would extract/implant and internal sinus lift all at the SAME time. This is a more advanced method but saves time and money. Waiting 2 years will result in some issues such as more extensive bone loss

  25. Dr. Amin, your blog is so straightforward, direct, and helpful. Thank you. So, I can’t make a decision about whether to go the root canal-crown route or extraction on my second upper right molar and part of difficulty is the trouble I had with only other root canal. I have a crowded mouth and all four wisdom teeth, so crowded that when I did invisalign about 15 years ago as nearing 40 they simply “polished” teeth to make room to straighten teeth. I was having problems five years ago with third lower right molar and my former dentist did a root canal. It did not work and she sent me to an endodentist who retreated it. I wish she had sent me initially to the endodentist because I felt quite a bit of pain while she was doing the root canal and was in terrible pain two days later. The endodentist treatment still didn’t work and he retreated it again. It still hurt and I had to have extracted. It turned out there was a fracture. The oral surgeon put bone in after extraction and I later had an implant. That developed an infection and I needed advil and codeine to manage the pain for 10 days. The implant survived and I have a nice crown, but about the easiest procedure during the ordeal was the extraction (aided by laughing gas). My new dentist who saw me two weeks ago when my gum was swollen around this molar says the bone is good and he’d save the tooth but if extracted he doesn’t think an implant is required and said that’s an OK choice too. I have a cross bit. Your blog was enlightening about how your bite impacts the decision on a replacement for upper molar. I have the money in an FSA account to cover cost that is not covered by insurance. I am so torn, but must make a decision this week as have let it go two weeks now and antibiotic runs out soon.

    1. We all grapple with these difficult decisions. Really it comes down to long-term prognosis. Ask your dentist what they would do if this where their mother’s tooth.

      You may be surprised what the answer is. Without seeing you or your x-rays are really cannot tell you exactly what to do because that decision tree is made by a clinical and x-ray exam.

      Perhaps have a second opinion before you take the plunge if your grappling with what to do!

      Thank you for your kind words. This blog form has been a passion of mine for over 10 years. I really enjoy the communication

      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. My dentist said I have abscess on the gum(there is no discharge just a tiny bump) above my upper right 2nd molar. That tooth has a crown and a post. He suggested to me to have it a. extracted or b. do the entire restoration. What would be a better option. I am 49 yrs old.

    1. If the tooth is savable with a good long-term prognosis the choice is obvious… Keep it! If it is going to be lost because it has limited tooth structure then it would be better to extract and replace it

  27. Hi, Doctor. Thank you for this useful site! My tooth #31 was extracted two weeks ago, due to the tooth showing both internal and external resorption on 3-D xray and determination by an endodontist that it could not be saved with a root canal.

    My questions are:

    1. I have the type of bite such that (without an implant) the tooth directly above the area of former tooth #31 would likely drift downward over time. (My understanding is that this is due to #31 no longer being there for the upper tooth to chew against, resulting in insufficient bone stimulation in the area of the upper tooth.)

    Given that I don’t want a titanium implant, I am currently testing a theory: I have purchased individually-wrapped sterile tongue depressors. I plan to regularly do an exercise where I pretend to chew, using the upper tooth and the tongue depressor. Using that exercise, I hope to cause sufficient, substitute root stimulation in the area of the upper tooth, so that the upper tooth does not start to drift downward. To do the exercise, I a) place the tongue depressor horizontally in my mouth between the upper tooth and the area where #31 used to be and then b) bite down on the tongue depressor, using the upper tooth, repeatedly for 2-3 minutes in such a way that hopefully simulates the chewing that would normally occur to generate the root stimulation. I plan to do this exercise 3x daily, after normal brushing of my teeth, for the rest of my life (or until it stops working to prevent the upper tooth from shifting downward.) I have already begun this routine.

    My question is, do you have any advice for raising the odds of this tongue-depressor technique being a success in preventing downward drifting of the upper tooth? When I had mentioned it during consultation with my oral surgeon, he deemed it as having a “maybe” chance of working, but stressed that chewing isn’t the only time the teeth come together–that they also come together when we swallow, for example. (However, I don’t actually bring my teeth together when I swallow because years ago I had heard on the radio that it’s not good for a person with a history of TMJ problems to put teeth together when swallowing, and that you should train yourself to keep your tongue in the way of your teeth, when you go to swallow, to lessen the stress on the jaw. So I took some time back then and trained myself not to bring my teeth together when I swallow, and it became my normal.)

    2. I have chosen not to seek a titanium implant because of multiple concerns that I have about it. However, when #31 was extracted, I did elect to have the bone graft done, in case I might decide later on to seek a zirconia (ceramic) implant as an alternative.

    My question is, do you feel a zirconia (ceramic) implant has a good chance of success in a 2nd molar area like #31? (If so, I may possibly consider at some point consulting with an oral surgeon specialist out East, where there appear to be way more oral surgeons performing the zirconia implant procedure than there are here in the Chicago area.)

    3. Now that #31 tooth has been extracted, my periodontist wants to check my bite in 3 months to see if I need to start wearing a retainer the rest of my life. However, I’m doubtful that a retainer would prevent shifting, in my case, because after having had braces at age 27, a retainer did not work for me to prevent shifting. (More detail: immediately after having had braces at age 27 to try and resolve my TMJ issues, I wore a tooth positioner at night for a while. Unfortunately, the tooth positioner caused jaw pain, so I asked the orthodontist if he could cut it in half, which he did, and then I just wore the upper half at night. But the upper half of the tooth positioner still caused pain in my jaw, so we gave up on that idea and he gave me a retainer to wear instead. But unlike the tooth positioner–which had been working to prevent shifting of teeth, the retainer didn’t work; my upper teeth went back to overlapping to some extent, and other teeth shifted a bit as well. Hence I’m doubtful that a retainer would work any better for me now than it did back then. Your thoughts?

    More Notes:
    I’m 63 years old with no current health issues. During my teens and early 20’s a total of 8 teeth–including wisdom–were extracted, to prevent crowding. I had painful TMJ issues back in the 80’s; open-joint surgery was recommended, but I managed to avoid it by having 6 months of neuromuscular therapy in 1992, which successfully eliminated my jaw pain and extreme head tension. I have been asymptomatic since that time, with the exception that whenever I have dental work, my jaw gets very tired and I so have to take breaks. I have neuromuscular massage every 1-2 months, which keeps my upper body relaxed. In short, I’ve been very fortunate.

    1. You may want to consider not having an implant at all. It is unlikely that the tongue depressor will work long-term. Some patients do not get this over eruption but most do. Perhaps he will be lucky. I am not a fan of zirconia for implants but it is a great material for the abutments and the crown! As for the TMJ the second molar often times makes a premature contact which can exacerbate a pre-existing condition. For most patients replacing this tooth would be the right thing to do but perhaps for you given your special circumstances you may want to just skip it.

  28. Hello. I hope you are doing quite well, Doctor.
    I am a 32 year old woman. I have had extraction of the molars #3 and #14 (U.S. based) and I just had a filling on molar number 2, due to cavity. It seems that the filling didn’t work out well for my tooth because nearly 3 weeks later I have a lot of pain.

    Problem is if I extract this molar, I will have no back molars on top right of my mouth. But the pain is bad. I can’t keep the molar if I will just be in constant pain. And my body seems to have rejected the filling weeks later.

    What should I do?

    Thank you, in advance.

  29. Hi I am 29 years old and I just had my Left upper second molar extracted yesterday….I had a root canal 10 years ago and the tooth just broke under the crown and had to get a complete extraction …the oral surgeon said I would not need an implant but I’m not sure….I have a history of developing bone loss after my wisdom teeth were extracted so I am worried about that now… also my left bottom second molar does not have anything on top so I’m worried it’ll move? Thank you in advance for the reply

    1. Is going to be up to you. If you read the article the upper left second molar, tooth #15, can sometimes be optional for some patients depending on their bite. It really depends on how much tooth surface/chewing surface was removed. Sometimes only 10% of #15 touches the lower tooth #18 while sometimes it is 90%. Each situation is unique. Stay safe during COVID 19

      1. Help!!! I am 25 and I got an ice cream from Dairy Queen a few days ago there was a rock in the ice cream and when I hit down I shattered and cracked tooth 15. I am getting it extracted tomorrow along with the wisdom took behind it. I just got my braces off and I’m so scared my teeth will shift.

        1. A rock!!!!!!! Yikes! Have your dentist evaluate your bite to see if you really need it replaced or not. It is ideal to have it replaced. That is what I would do if our at your age in your situation.

  30. Hello Doctor.

    I have had 3 infected root canals that need to be extracted as they cannot be saved.

    The dentist is a implant specialist and is trying to convince me of doing implants.
    I was quoted with a massive bill $13k, and I have no insurance.
    He was selling me on the idea of bone loss and spacing, however from what I see on your website it looks like it may not affect me? Otherwise, my teeth are in good condition and straight.

    The teeth I have affected are 15, 32,31 on this image..


    Please let me know what is the best decision. I am only 28 and cannot afford this. I could maybe get implants in the future, but this serves no aesthetic purpose for me and my smile.. just functional at this point

    1. Thank you for your thorough question. If anything I would just replace tooth #31 and not worry about 15, 32.

  31. (I’m resubmitting this comment as I realized I did a poor editing job on the first submission. Feel free to use this one for responding.)

    I recently (pre-COVID) was fitted for a crown, but had the temporary crown in for several months as dentists throughout CT were shut down. When my dentist reopened, I returned to have the final crown fitted, but I informed my dentist I was experiencing some discomfort for the past couple of weeks above the temporary crown. Another x-ray was taken and he informed me that a root canal was likely, so I was referred to an endodontics specialist, who during the process either discovered the tooth had a hairline fracture or it fractured while drilling. The root canal was not completed. Is that a common occurrence? Regardless, now I’m off to see an oral surgeon for possible tooth extraction and implant. This is the #3, upper right. My wisdom tooth was extracted years ago, so this is the second tooth in on the upper right, labeled #3. So my questions are: Is this a common/not-unusual event? And are there other options than extraction/implant? Can I have an extraction without an implant considering its location. Thanks. Just looking for additional perspective.

    1. It sounds like you went to a good endodontist because they abandoned the root canal when they saw small crack. This is not totally uncommon. An implant would be a much better option than having a bridge. That would be your only other real option besides just leaving it alone as an empty space. Keep in mind this particular tooth is close to the sinus so sometimes the sinus needs to be lifted up a bit at the same time of the surgery or separately depending on the skill and experience of the dentist and your unique situation. Stay safe during COVID-19 🤗

      1. Dr. Amin, thanks much for the response, as well as the additional information related to the sinuses. I have a conversation scheduled with the oral surgeon tomorrow, as well as my original referring dentist.

  32. I recently (pre-COVID) was fitted for a crown, but have had the temporary crown in for several months as dentists throughout CT were shut down. When my dentist reopened, I returned to have the final crown fitted, but I informed my dentist I was experiencing some discomfort above the temporary crown. Another x-ray was taken and he recommended I see a Temporary put in but the final never was as dentists were shut. During the shutdown, the area above the tooth began to bother me and with a further x-ray after my dentist returned, a root canal was recommended prior to the final crown being installed. Was referred to an endodontics specialist for the root canal, who during the process either discovered the tooth was fractured or it fractured while drilling. I don’t know know how common that is, but now I’m off to see an oral surgeon for tooth extraction and implant. This is the #3, upper right. My wisdom tooth was extracted years ago, so this is the second tooth in on the upper right, labeled $3. My question is this a regular occurrence, are there other options than extraction/implant? Can I have an extraction without an implant considering it’s location. Thanks. Just looking for additional perspective.

  33. Hi, Dr. Ramsey , my oral surgeon wants to extract teeth 2 and 15, both top second molar in order to proceed with my jaw surgery. I previously had 8 teeth extracted for braces ( 21,28, 5 , all wisdom teeth and a lower 2nd molar.) I want to know if my removal of 2 and 15 will cause facial asymmetry and bone loss or not. Will it change my appearance? Also , do I need to get these 2 teeth replaced for chewing?

  34. Hi Dr. Amin,

    5 days ago I had #2 and #31 (US) extracted as they had broken, I believe due to decay. I suffer from bruxism and am on route to periodontitis. In 2014, I had 5 impacted wisdom teeth removed. I lost my dental insurance so cost is definitely an important factor at this time. I have been doing some research and am now very concerned that my facial shape may change and become asymmetrical. I am only 27 years old so this is a big concern for me. The dentist who extracted my teeth was in a rush and didn’t explain any options or anything regarding bone grafting to me. She told me I would be, “just fine” and moved on. In your opinion, what is the likelihood that my facial shape will change? Also, do you think a bone graft is necessary to prevent any asymmetry? Thank you for your help!

      1. Hi. I am 17 years old and I have gotten number 31 removed. Do I need to replace it and if I don’t will the rest of my teeth in my mouth start moving later in life and look weird? I chew perfectly but I’m really worried

        1. Your teeth will move but you are a bit young for an implant. You can make a special retainer that will hold your upper tooth #2 from moving for a few years hopefully. That is the tooth that bites with #31

  35. Hi Dr. Amin,

    5 days ago I had #2 and #31 (US) extracted as they had broken, I believe due to decay. I suffer from bruxism and am on route to periodontitis. In 2014, I had 5 impacted wisdom teeth removed. I lost my dental insurance so cost is definitely an important factor at this time. I have been doing some research and am now very concerned that my facial shape may change and become asymmetrical. I am only 27 years old so this is a big concern for me. The dentist who extracted my teeth was in a rush and didn’t explain any options or anything regarding bone grafting to me. She told me I would be, “just fine” and moved on. In your opinion, what is the likelihood that my facial shape will change? Also, do you think a bone graft is necessary to prevent any asymmetry? Thank you for your help!

    1. This is a great question Rebecca. Missing #2 and #31 is not going to lead to facial shape changes and becoming asymmetrical even though those 2 teeth are both on the same side. You have to lose more teeth especially the first molars which are numbered #3, #14, #19, #30. If you do have periodontitis this could lead to the loss of all of your teeth having severe bone loss and facial changes like this.bone loss and facial changes like this.

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

  36. Hi, I’m 46 and have just had my lower left second molar removed*. I still have my wisdom teeth, so now I have a gap. How long is it okay to wait to have an implant done?

    *the molar was extracted after it fractured 10 weeks ago. Due to the covid crisis my dentist was closed and I had to go on a waiting list for an emergency consultation. When I eventually saw the emergency dentist he told my it could be saved with another root canal treatment and then crowned, but, that service is not available until Jan 2021 ‘apparently’. I had already taken three courses of antibiotics to help with infection which kept coming back and honestly, after 10 weeks of utter misery, I said rip it out. Plus Jan 2021 is six months away, there’s no way I was prepared to wait that long, and risk the infection getting worse.

    Thank you kindly for your time if you reply!


    1. Hi Aaron,

      It sounds like you need a new dentist! January 2021! That is ridiculous! This would be a great area to have an implant especially at your age. This exactly describes the problem in the article about missing the last molar. It is more critical went on the bottom than on the top. Stay safe during COVID 19

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

  37. hello dr i just got first molar on the lower left side (#30?) removed today and i want an implant so i dont fully mess up the others and when should i get it done? my doctor didn’t talk about it at all during our appointment he was rather dismissive just pull n go attitude really

    1. Hi Dr. I have had A molar extraction number 31 using the United States labeling is a tooth replacement needed ? I was also told I would need to lose number 19 any advice ? 🙁

  38. Hi,

    I had my upper 2nd molar removed 1 year ago. I noticed the lower 2nd molar below it is a bit higher than the adjacent teeth. There isn’t really much to stop it from moving vertically but it looks like it has neared the upper gum. Is this a cause for concern? Would something like a night guard help to stop it from moving? I don’t feel pain or sensitivity, Just noticed it randomly.

  39. Hi Dr.,
    I must commend how you handle dental related issues on this platform and I wish I had discovered earlier, I wouldn’t have been in the current situation I find myself. I am an African and will be 40 this year, over the years, I’ve had causes to extract tooth numbers 5,18, 19, 30, and 31 (using the United states labelling system). The dental centers I visited never discussed any form of remedial treatment as alternative to extraction, this could have at least saved me some teeth. As we speak, number 32 is affected and may possibly be extracted also. I also noticed recently that I frequently have itchy ears, could it be that my ears have been affected?
    Please doctor, I do not have the finances for now to travel abroad for any form of treatment even when all the Covid-19 issues are all over, but I need your advice on what to do regarding treatments, implants, or whatever I need to know when next I visit any dentist in a standard hospital.

    Thank you.

    1. Thank you for your kind words. I am sorry that you had some issues. The itchy ears are not related. You may want to see a dermatologist for that question. As for tooth #32 generally provides no value and is a source of periodontal disease.

      As long as you have molars #3, 14, 19 and 30 you will be in good shape long-term for most patients bite types. If you are missing any of those teeth I would suggest replacing them. The second molars are numbered 2, 15, 18, 31 and are not as important if you are missing multiple teeth.

      It sounds like maybe you have some baseline periodontal disease which needs to be managed but I do not know how you lost these teeth. People loose teeth due to decay or due to periodontal disease. Both are preventable so please connect herself up with a very good dentist that can give you a comprehensive treatment plan and then do regular maintenance procedures and home care so that you can keep the teeth that you have. Replacing tooth #5 can be straightforward as long as there is no bone or tissue lost requiring a bone and/or gum graft.

      1. Thanks Dr. Ramsey for your prompt response to my enquiries in spite of your busy schedule.

        I will want to send you some images for you to further advise. Can I reach you via email, please?

        Thank you.

        1. It would be best to see me in person. I wish I had the time to personally look x-rays at the 100s of messages I receive daily. Feel free to call the office to make an appointment. Respectfully, Dr. Amin

  40. Hello I am 21 years old. I have a cracked molar on number 15 I’m in so much pain the dentist recommended me to an endo to try to save it but he doesn’t know if they can save it and because of corona virus I have to wait to see an endo. Or I can have it extracted which I’m leaning towards. Can I get an implant in the future if they just fully extract it I don’t think the OS does any pre implant stuff. I have an over bite and my bottom molar is still in place how long do I have before it shifts? I also already had my wisdom teeth removed

    1. Can I get an implant in the future if they just fully extract it? YES!
      At age 21 your teeth are likely to shift FASTER than if you were 41. The sooner the better.

      1. Does endodontic treatment last forever.? I heard there were a lot of well-known dental professional claiming it impossible to sterilize the tubules fully as there are millions of it in a compromised tooth, which can harbor bacteria and potentially harm a person’s health. Even it the canals are sealed up with gutta percha filling, it’s edotoxin can leak out in matter of time. Do you practice holistic dentistry that assess every aspects of your patient before proceeding with such a major dental work?

  41. I’m 41 years old and my molar on bottom right needs an implant. I want to know if it would be safe to just extract and will I have future pain from upper molar? Thank You

    1. Read the article a second time. If it is the bottom molar it is likely a better candidate to replace than to leave it as an empty space. Your upper tooth will over erupt causing future issues if you have a normal bite pattern. Stay safe during COVID 19!!!!

      1. i’m 30 years old and i had to get both my lower left side last 2 molars removed, as i didn’t have money to get it fix. and the last tooth left on my lower left side needs a root canal. i’m so scared as to what will happen to my smile since i don’t have money to fix my teeth.

  42. I’m 41 years old and my molar on bottom right needs an implant. I want to know if it would be safe to just extract and will I have future pain from upper molar?

  43. I am 67 and most of my teeth are in decent shape. But the rearward most molar on my upper right side (I think that is #2) is dead and breaking apart. Both an endodontist and an oral surgeon have said it needs to be removed, it cannot be saved. I have the procedure scheduled. But I need to decide if I want an implant or not, because if I just want to be able to have an implant later on, the surgeon says I need a “Sinus alignment vertical” and a “Platelet rich fibrin.” Neither are covered by insurance. Then if I decide on the implant sometime later, that is really expensive and only 50% covered by insurance. But if I am sure I don’t want an implant, it is just an extraction. What is the downside of just doing the extraction?

    1. In this article I specifically discussed the upper molars. You may be okay without it but this really depends on your bite.

      1. Thank you so much for your guidance in the article. As it turned out, my appointment to have the molar removed was delayed a month due to the COVID thing. But then the molar started to break apart and I had to get an emergency appointment with the oral surgeon to have it removed. I told him to skip the pre-implant procedures and just get the tooth out of there. It went well but he said that what he encountered with the position of the molar relative to my sinus would have made an implant more difficult that he originally thought, so it was just as well that I chose not to have one. I’m all healed up now and everything is fine. I can’t do hard chewing on the missing molar side, but other than that, I don’t miss it.

  44. Hello,

    I got my 2nd molar in the lower jaw removed when I was 10. I recently noticed that my wisdom tooth is starting to grow now. Is it possible that it will grow in the place of my 2nd molar and it completely fills up that gap?

    1. It is possible because of the age that you had your second molar removed. It can also orthodontically be pulled into place. This is because of the timing of your extraction. See an orthodontist ASAP. I am assuming you are between 17 and 25 years of age.

    2. My 14 year old daughter has been very delayed in losing her baby teeth and adult teeth forming. Most adult teeth are in now with a couple of exceptions. #29 is a baby tooth that does have an adult tooth that has been slow to form but dentist said it is looking like it will with a little more time. #20 has no adult tooth formed at all under it. She has no wisdom teeth per x-ray but her bottom 2nd molars are trying to come in. Dentist said there isn’t a lot of room for them. They have offered a couple of options: #1-Let #29 come in, file the sides of #20 down just a little to give more room, then put on braces to pull teeth together (her teeth seem to be shifted a little off center from center of face and she has an overbite anyway so she needs them). They hope that it gives #18 & #31 room to come in with no problems. If so great, if not pull them both. Said she would also most likely need an implant in her early 20’s for #20 OR #2 option-pull both #20 & #29 and use “T.A.D” anchor system in that area along with braces to pull the two molars inward to give them more room. Said keeping molars would be best option because molars are stronger teeth than the others but the concern was that molars take longer to move with orthodontia and my daughter had a really big issue in her first phase of braces with decalcification and battling her with proper cleaning,. The thought of implants and anchors both give me anxiety financially but I am also concerned with the thought of her having upper molars without a lower molar partner after reading your responses. I do not want to cause major dental problems down the road by making an uniformed poor choice now. What are your recommendations and what are the potential problems with either option?

  45. Hi Dr Ramsey,
    I am going to have the teeth #15 to be removed next week. I don’t plan to do the implant of this teeth in the future. My dentist suggests me to do the bone graft at the same time of extraction of this this teeth because this teeth gets infection and has a deep hole.
    Do you think I should do the bone graft if I don’t plant to get an implant of this teeth?

  46. I had #18 extracted and I an thinking about getting an implant even though I don’t have any chewing difficulty. . Several dentists have told me that I grind my teeth but I am not aware of it. Would a molar implant be able to withstand the force of moderate teeth grinding or would it likely fail. Also can an implant cause periodontal disease or bone loss in adjacent teeth?

    1. A type of implant that should be selected for somebody with your bite strength should specifically be grade 5 or 23 titanium. The second molar has a high bite force and a thin walled implant may break. I have done 100’s of these with great success

      An “bad” implant can case bone loss but unlikely. You would know there was a problem before it got that bad

      1. I have Bad teeth. I have 11 teeth upper & 11 teeth bottom, the dentist wants to pull all 4 / 2nd molors. That leaves me with 9 upper & 9 Lower. Not much to chew on,& my face is already sunk in.what to do?

        1. Not a bad plan… It is the molars that are typically the most affected by decay and periodontal disease. If you have your bicuspid teeth you may be okay as long as everything else is very solid

          1. Dear Dr Amin,

            By bicuspid teeth you are referring to the premolars. The 4th an 5th teeth before the first molar right? May I ask if all the teeth are intact, but there is a missing number 18 (lower left second molar). In this case, would the opposing still shift down if it has a little contact with the lower first molar.

          2. Yes, I am referring to the premolars. Bicuspid then premolars are synonymous. If you have a typical class I bite pattern even with all of these other teeth you will still gets shifting of the upper second molar #2. This may cause some TMJ problems down the road and periodontal disease on #2 and #3 because of a pocket that becomes deep.

  47. I am having trouble with upper left side molar (tooth 27). It is causing pain now and dentist says I should either get it extracted or root canal done. The tooth has already been comprised with a very large filling. I already have the last molar (wisdom tooth beside it) removed previously.

    My dentist seems to feel that either option are fine with him. Just wondering what are chances if I have it extracted that I will have other problems later as a result of tooth 27 missing. I do not really want to be faced with an implant to be honest.

    Thanks for any advice

  48. On January 17th, 2020 I had my upper right wisdom tooth extracted, it was healthy, had enough space and had grown in properly. My dentist said that the upper wisdom teeth were pushing my bite forward and that’s why she extracted the tooth. Problem is that some years ago I had both of my upper premolars extracted for orthodontic treatment. My bite got messed up again due to untreated tongue habit after the removal of the braces and not caused by the wisdom tooth. The space left after the removal of the tooth is huge and I’ve trouble chewing on that side, I feel like I lost a lot of strength on that side of the mouth and I’m constantly getting the gum prickled when I’m eating. Would an implant be an option? What would you suggest? I’m also in need of orthodontic treatment to fix the bite and treat the tongue habit. I’m only 21.

    1. braces first followed by implant second…but the implant must be PRE-PLANNED before starting the braces so the space can be managed. Do not take off the braces until the implant dds clears you to do so

      1. Would there be any more risks to be considered compared to the implant surgery of a different tooth and not a wisdom tooth? From what I’ve researched online I’ve not been able to find much information in implants for a wisdom tooth. Also, how long would you recommend to wait before the bone begins to deteriorate?
        Thank you Doctor!

        1. Are you wanting to have an implant for your wisdom tooth? That is not recommended. There are so many anatomical restrictions in those areas and also they do not provide any sort of chewing capability.

          You’ll be hard-pressed to find someone that would put an implant for wisdom tooth 🦷

          There is a different type of implant that I specifically place in the wisdom tooth area called a pterygoid implant but that is very specific to full upper replacement


  49. 52 years old. Yesterday had an extraction on 2.
    5 years ago had a root canal and subsequent crown down on 3.
    Is it imperative that I get an implant for 2?

  50. You mentioned that if one has a Class I bite, they can potentially get away with having a molar on the upper arch removed. I have a minor cross bite and tooth #2 has an abscess but I can’t handle the pain for a month nor can I afford the root canal. Will I be shooting myself in the foot by getting it extracted?

  51. Hi,

    I’m 58 and had to have #18 extracted due to a large crack. I have bruxism and have for years. I only have one crown #17. So otherwise teeth are healthy. My wisdom teeth were removed in college.
    I cannot afford an implant so do I have any other options? Do I have to do anything?

    1. There is always the choice for no treatment. At your age things may be stable. You should definitely monitor this every 6 months by x-ray. The opposing tooth would be #15. That is the tooth that should be watched for drifting. Course consult with your dentist about this.

  52. Hello Ramsey.

    I hope I am not too late on the post. Discovered this article today and I find it very informative. Thank you. I have my 18,19,30,31,32 removed. Looks like i will have to also remove 15 and 17 as they now have holes. My question is, can i also remove 1,2,3, 14 and 16 and not have implants or are implants a must? Your response will be greatly appreciated.

    South Africa

    1. It would be best if you had 3, 14 , 19 and 30. That would give you one crucial molar in every quadrant. This is ideal ✅

  53. On January 21, 2020 I got an extraction on 18. How long do I have to wait to get an implant? When do teeth start to shift? Would I need an implant? I’m only 21 years old. Are tooth implants safe to get? Is there any danger in the further?

    1. I usually placer the implant on the same day of the extraction. If not, 4 Months is a good timeline. An implant would be suggested in this scenario

  54. On January 21 2020 i got a tooth extraction on 18 would I need to get implant? How long do I need to wait to get an implant? When do teeth start shifting? Will my teeth shift?

    1. In my practice that would be a same-day extraction in same day dental implant. If you are having a delayed placement then wait about 4-6 months before doing anything

  55. Last month I had to have #31 removed because it cracked down the root while a filling was being put in. I have a root canal in #2 that is about 25 years old. I am 52 now. I had both wisdom teeth removed when I was 22. Will I loose #2 also because it will start reaching for #31? I can’t afford a dental implant and at 52 if I have problems with #2 should I just have it pulled also?

  56. Hi Dr, Amin. Thank you so much for posting about this. I had all 4 wisdom teeth removed in high school. A few years ago, I had a root canal and crown on a second molar (#18, left side, bottom, far back). The root canal failed and the tooth became infected so my DDS fully extracted it. He says the upper molar (15?) is starting to come down and suggests I get an implant in 18. He said it was not vital but worst case scenario is the upper molar will eventually come down so far it will need to be removed (and this could take anywhere from 5-10 years but it’s impossible to be sure). He also said the implant would be more dire if the tooth adjacent to 18 cracked or failed. This is a lot of money and it’s major surgery. I am 38 years old. Should I get the implant? Are there any additional concerns for an implant that far back? Nerve damage? Infection? Thank you so much for your time.

    1. A skilled implant dds Will greatly reduce risk of nerve damage and infection. If these is enough space for a normal size crown on the implant I would have it done SOON! If it is too tight then plan on losing 15

    2. Hello I have to have tooth 18 and possibly 17 extracted due to a cracked root and infection. I am 53 years of age. Can I get away with not getting implants to replace these teeth?

  57. Hi Dr. Amin
    I am planning to get a titanium implant for a lower 2nd molar that was recently extracted. The 1st molar has amalgam fillings and I was wondering if that would cause problems with galvanic corrosion.

  58. Hi,

    I got all four of my wisdom teeth pulled as well as a bottom second molar. They pulled the molar because it was decayed and cracked, and my bottom row are overcrowded anyway. I’m now realizing from reading your excellent post that I might probably need an implant in the near future to replace that molar. However, I am pretty sure that they did not do a bone graft. Will that negatively impact my ability to get an implant? I’m getting very concerned about bone reabsorption and tooth over-eruption, since these are things that were not discussed with me prior to getting the molar removed.

    Thanks for your help!

    1. You don’t need a bone graft all the time. Just get it done quickly because you are 24. See a really good DDS! Happy New Year!

  59. My dentist filled a big cavity in #15 two months ago, and it still hurts. She recommends a root canal, which my plan will cover in 2020, but I don’t know if I can tolerate the pain for 4 more weeks. Can I just have #15 extracted and not replaced? I’m 44.

  60. My son is 18. It has been recommended that he have #15 and #18 pulled. He has a retainer for both top and bottom. Will he need implants to maintain the structure of his jaw or just new retainers? Also, will he have issues chewing? Thanks.

  61. When I was 27 i had the removal of all my wisdom tooth due to they were laying horizontal. In prior years I have had a root canal on #13 and the tooth continue to break within days and I only have the root of the tooth. Years later I had root canal on #28 and also, within days the tooth broke and feel out completely. I have a chipped # 31 and is causing pain and was recommended a root canal. Yet, I fear i will also fall out. Should I proceed to extract or should I do the root canal and hope for the best.

    1. It sounds like you had root canals on teeth that were NOT savable in the first place. I would go to a different DDS for the crown/root canal!

    2. It sounds like you had root canals on teeth that were NOT savable in the first place. I would go to a different DDS for the crown/root canal!!

  62. Hi Doctor,
    I am 25 years old. I had a root canal done on molar #18 and it is now infected. I also have a fractured molar #15. My dentist recommended a root canal for both but I do not want to do that and end up with more infections. Both of the teeth are starting to become painful and I would like to extract them. If I extract both, do I need to put in implants for both? Would I be okay without any implants? If I do have to get implants, how long could I wait?
    Thank you for your time.

  63. Hi Doctor,
    I am 25 years old. I had a root canal done about 4 years on tooth #18 and it now has an infection. I also have a fractured tooth #15. My dentist is recommending root canals for both but I do I not want to do it and end up with more infections down the road. They are becoming painful so I would like to get them extracted. If I remove both, can I leave that space empty or do I need 2 implants? Will all of my teeth shift backwards?
    Thank you very much for your time.

  64. My #18 bottom molar is cracked and requires removal rather than crown. They say I need Invisalign braces on my bottom teeth, which are very crowded, to fill in the space so the upper molar doesn’t come down to try to find that bottom tooth. I still have the wisdom tooth beside it. Do you think braces are necessary?

  65. You have a clear, concise style that is informative. With continuing pain after 2 root canals on upper 2nd molar I am ready to get it pulled. Am hoping to get away w/ no implant as have already spent thousands and am tapped out. Was told by a friend I should make sure they remove the periodontal ligament during extraction. Is this standard practice? Thanks.

    1. It will dissolve on its own once the tooth is gone. Nothing needs to be done any differently than a standard extraction. Sometimes there are holistic dentist that make up strange procedures that have no scientific basis.

    2. It will dissolve on its own once the tooth is gone. Nothing needs to be done any differently than a standard extraction. Sometimes there are holistic dentist that make up strange procedures that have no scientific basis..

  66. Thank you for your informative article and delightful, direct communication style, responding to questions.

  67. My #2 bottom molar needs to be extracted. But my wisdom tooth has not come through. When I have my #2 molar will the wisdom tooth come through? I am thinking of waiting to see if the wisdom tooth comes in after extraction instead of getting an implant. What is your recommendation?

    1. In this article says
      So do you need to replace this tooth? If it is the bottom molar and you still have the upper opposing molar than I would typically say yes. The reason for it is if you do not replace the bottom molar, the upper opposing second molar will begin to over erupt out of its socket trying to reach its old partner that got extracted.

      1. My lower molar needed an implant 7 years ago, I couldnt afford it back then. My x ray shows top molar has erupted from socket , is there any option to fix it besides extracting? Is it to late to get implant ,which kind do you recommend and do I need to get implant for upper and lower molars?
        Thank you

  68. Hello Dr. ,

    Tooth #31 is decaying because it cracked while eating some chips , dentist said it was too far gone to save and that a root canal , bone graph and implant followed by a crown will be necessary .
    I have insurance but supposedly they don’t pay for the bone procedure .
    Would my best option be to extract #31 and #2 to avoid the upper #2 hitting lower gum and getting a retainer like I read in one of the comments? I’m scared of future issues with bone graphs and infections .
    Also I have #17 , which I believe is giving me issues with my ear canal .
    Would I have any issues removing the teeth I mentioned?

    1. Although you may read about comments with problems, most pts that are treated by a skilled DDS have no problems at all.

      Just replace 31 and keep 2

      1. Dr. Ramsey,

        I am in a similar situation at stated above however my dentist is recommending that my bottom 3rd molar #32 be extracted and have an implant place. I am not leaning towards the implant due to extreme cost. She stated that if I don’t get an Implant that it will cause me to talk funny and my upper molar will start to fall down. However, my upper molar #1 has a root canal and a crown so is this possible? I am also in braces which are scheduled to be removed in the next 12 weeks. What are you suggestions

  69. Hi,
    I went to the dentist who told me I need a root canal on my top last molar. My wisdoms teeth have not come through yet. I am 28 so may not but on the X-ray it did look likey wisdom tooth was impacted on my last molars root. The root canal will cost $1600. Is it worth it? Or would extraction be an option to consider?

  70. No wisdom teeth, and my #14 (US) was extracted last year. Fully healed and no chewing problems. You have mentioned 14 is super important. Can you please clarify a bit? So an implant is absolutely necessary even if partial half-tooth contact still exists?

    1. Yes. This is a critical tooth that anchors the upper jaw at the base of your cheekbone.

      People that are missing this to tend to have facial changes over time making them look old.

  71. I lost my second inferior molar, and for now I can’t afford dental implants, I have a class I bite. My first inferior molar is crowned. My question is, may I enlarge the crown of my first molar in order to have more teeth to match my second superior molar, like 3mm.

    1. It is not a bad idea but over contouring teeth may exchange one problem for another. Over contoured natural teeth tend to get pockets and periodontal disease. This is a decision from a dentist to make

  72. Great well written article!

    I had tooth #15, 16 and 17 removed. The lower ones were removed first. Do I need implants?

  73. I have a crown on my right 2nd molar which has a #7 pocket. That’s what my dentist said when I had my teeth cleaned. He referred me to a periodontist who says I should have an implant. Could I have the tooth removed and then get a permanent retainer or maybe just treat the molar and see if it gets better. I have no pain or bleeding. What are your thoughts.

    1. This is possible but typically retainers will not prevent the super eruption of the tooth where it starts to stick up higher than the rest. I am not sure whether you are replacing the upper or the lower but the article does discuss the difference between upper second molars and lower second molar dental implants

      1. My dentist extracted number 17. There was some complications he had to grind on the crown in order to get the wisdom tooth extracted. He took an xray after. There was no bone graph or implant. What should I do?

  74. Thank you for the article. When I was about 16 I had an infected molar extracted, my first molar on the upper left side. Later on my wisdom teeth came in, and I had all but one removed – the upper left wisdom tooth was left in to “replace” my missing first molar. I am now 26, and the gap has fully closed, but it doesn’t feel great – my second molar is tilted upwards towards the old extraction space, and does not touch the bottom molar when i bite down. when i bite down i only feel it on my right side. I think this has caused me to grind my teeth a lot and my right molars are showing a lot of wear. The part that bothers me the most is that my top midline has shifted a lot to the left. I don’t know if this is caused by bone reabsorption, but my top front teeth look really asymmetrical to me now. i really used to like my smile, and i really want to get this fixed.

    What is your recommendation? Do i need an appliance to open up the extraction space and place an implant in it? Will I need braces to move my midline back or will that happen naturally once the implant is in? will they even do an implant since technically i have the right number of teeth on both sides because my left wisdom tooth was not removed? Will I need a bone graft?

    1. the most simple solution for you is to just get orthodontics. Whether that be in this align or classical braces likely this will fix the problem your young age of 26. The tooth can be made to be upright and correct the midline etc. Make sure you see a very skilled orthodontist and do your due diligence.

  75. Hello Dr.
    Two weeks ago I had my upper second molar extracted. I’m constantly rubbing my tongue against the tooth that is next to the one extracted. Also, I’m sucking my cheek against this same tooth. Is this a normal nervous habit that happens after an extraction?
    Thank you.

    1. I live you Canada. Due to infection since April, I’m supposed to get molar 47 removed, 48 has already been removed years ago. I was going to leave it without an implant, because they are so costly and take time, many appointments, to put in place but after reading this I should change my mind and have the implant, right?

    2. Just wanted to say — I’ve been guilty of doing these same habits over the past few years since a gap was created in my upper molars a few years back. To the point that I would make a clicking sound with my cheek from sucking the cheek against my teeth which eventually started irritating my cheek. I have since had a root canal in one molar and then just had the second molar removed last week. I was hoping with the extraction that I would stop the habit…

  76. Dr. Amin,

    I am a 57 year old male who had the #15 upper molar extracted several months ago. I was planning to have an implant done. I was told I will need the sinus lift procedure first, based on CT scan exam.

    My question: What would be the drawbacks if I elected to not have the implant done. What would be the likely effects on long-term dental health, appearance, etc? Would I be in any danger of other upper teeth shifting over time, lower molar erupting, or any other concerns? Just based on my own judgment, I seem to have the Class I type of bite you discussed in your post where my lower molar contacts half of the next upper tooth over when I bite down. Thanks.

    1. it sounds like you kind of answers your own question. You definitely landed on the right article. The benefit of adding the upper second molar is often up to the patient

  77. I have the exact situation in the example given in the article: my bottom second molar was extracted 7 years ago. The upper second molar is now supra erupting. I can’t afford a tooth implant. Can extract the upper molar, then get a permanent retainer to keep teeth from moving? (I currently have a permanent retainer on my bottom teeth.)

    1. Dear Dr.Amin,

      I might need to get my bottom first molar removed. I have not got my wisdom tooth extracted. Is it possible for my second molar to replace my first molar and the wisdom tooth take the second molar’s place?

      1. Really great question! You have to be very young in order for the wisdom tooth to drift into place of another molar. Typically he would need to be between 10-15 years of age. Orthodontically is hard to move that tooth forward after you are older.

  78. Hi, I need some advice regarding this. I’m 30 now, I had my bottom left 2nd molar removed due to it partially being decay by the wisdom tooth partially erupted.

    I had both the TOP wisdom tooth removed already.

    I did not had my bottom left wisdom tooth removed due to it being too near to the nerve.

    Now that it is clear from the nerve, i had some problem of it affecting the 1st molar and it is crooked outwards of alignment.

    My question is, should I do extraction+implants OR should I do a braces to fix the alignment of the tooth?

  79. i had my 18 and 19 tooth removed. bone graft is done. I am extremely sensitive to the changes in my body or surroundings. if i decide not to do anything like implant how will my teeth shift. ? I am 42 year old female and in great health. all other teeth are also great. Dr said to have to bone graft just in case so he did it during extraction. I was hoping i can chew from that side (may be soft food ). i would really appreciate ur advice doc.

    1. Part of why you are in great health is because you have 18 and 19!!

      It is a slow downward spiral once all the molars on one side have been removed.

      You will do great. I have many patients just like you 🙌🙏

  80. Just saw my dentist. My #31 tooth has cracked since getting a root canal 4 yrs ago.
    Lots of pain but advil and tylenol are alleviating it a little. I will def have my tooth extracted, but I am up in the air about getting an implant. I did read your post about replacing the cracked tooth with an implant, but cost is my concern. Can I get my tooth extracted this month, and maybe a year or two from now get an implant? Thanks so much.

  81. Hello I’m 27,
    Theres a possibility that I might need to get one of my 2nd molar on the upper jaw removed,
    Is it nessasary to get a dental implant?
    Will it change the shape of my jaw due to bone reduction?

  82. My bottom second molar tooth broke a few. month back ehile I was eating. I basically left it untreated and now the right side of my face (jaw) is constantly throbbing and cramping up. What exactly should I do?

  83. Hello, your article was very informative – question, I’m 66 y/o, my 31 molar had a root canal with a crown placement many years ago, but since I had it done it has always bother me, while chewing food on and off. On occasion I’m unable to chew with that tooth, too painful. My dentist said the following: sending me to see an Endodontist or a Prosthodontist. I will like to know what would be your suggestion.

  84. Hi ,
    I have my bottom second molar extracted. My surgeon told me there is a good chance the top molar would shift down, since teeth need contact with one another. But I don’t intend to get a dental implant, what are other possible actions rather than ignoring it. As it would cause further periodontal diseases to the other healthy teeth.

      1. Thank Dr for the implant I did it was buried underneath my gum. However through the x ray, I saw the distance between my implant and natural tooth was a bit far apart. How it affect my implant crown placement? How there be a gap?

          1. Sorry Dr cant provide you with the photo as it does not support photo attachment. Have more questions in mind. How long would it take to make get the crown after uncovering the buried implant.? And how do make implant for second molar lasts a lifetime.

          2. Hi Dr,
            I am having systemic symptoms such as flu and dry mouth. My periodontist was not sure is it titanium allergy. But it is making me sick and fatigue. Should it be removed with zimmer biomet.?

          3. The chance if it being your implant is Lower than half a percent or less. That is a good brand. Likely just coincidence!! Get well! 🤗

  85. Thank you for sharing Doctor! I had my 32nd molar extracted 6 years ago (age 24), similar to this story. But my #1 top molar rests/bites on my bottom 31st molar. Originally my oral surgeon said an implant may not be necessary because it was less like for the upper tooth to erupt. Would you agree? Would I need an implant to prevent jaw bone loss? Thanks for your help!

  86. Hello Dr.
    Thanks for your time…
    Do you prefer zirconium implants vs titanium due to its biocompatibility?
    What implant type do you recommend for all missing molars in back of mouth, both top and bottom? I hate wearing partials- they make my mouth feel like plastic. Getting implants would help me eat and enjoy food again. My molars were extracted in August 2018 when I decided fully detox my body and get rid of teeth that once had mercury fillings and composite fillings due to their toxicity to the body. I now need teeth again! I’m heavily considering Zirconia because metal doesn’t belong in the human body.
    Thanks in advance!

  87. I’m in trouble. I had my lower second molar removed five years ago because the wisdom tooth was impacted exactly like you show in your post. And my upper second molar has erupted out of its socket. My dentist had told me implant was optional. Is there any way to push it back into socket, or do I need to get it removed? Thanks

      1. Hi Dr,

        I have the same situation as Husain and i am in dilemma. I am currently on braces to intrude the upper tooth so that I can do an implant but it’s not working. My orthodontist suggested to intrude it using screws to put back in place. Do you think it will work? Or should I just forget about the idea and take out the tooth when it touches the lower gum?

        Thank you so much for your professional advice.

        1. I have screws in my daughter’s jaw to move things around…. That should probably answer how I feel about it 😉

          1. Hi doctor,

            Thank you for replying my previous post.
            Based on your previous comment is it recommended to do the screws ?

            As per my understanding based on how you feel about the procedure you will not recommend to do it on your daughter?

            My apologies if there was any misunderstanding

            Thank you

  88. How long can I wait from the time my implant post is placed, to having the crown put on? They say 4-6 months is typical, but can it be longer? Maybe 6-12 months? Pros and cons? Thank you!

    1. that timeline should be okay. The main disadvantages would be if the other teeth shift in the area or the bone begins to shrink more aggressively. 6 months is most ideal but I’m sure it will be okay

  89. I am 47 years old and been on osteoporosis medicines for 9 years due to premature menopause. I have an upper tooth (the one next to the last one) that has a crack and needs to be removed. I know the risks of osteocronosis of the jaw and higher risk of dental implant failure due to the medicines. Should I try for the implant or a bridge?

  90. Your article has been helpful! I am deliberating on an implant after tooth #2 is removed. I read your article and it mentioned the bottom tooth was a bit more important so I am thinking about saving the money. Any additional thoughts would be appreciated.

  91. I had #15 pulled in January 2018, the socket is all healed over now and I am used to the missing tooth but I am considering the possiblity of an implant. My question is can an implant be installed into a socket that has healed over and has had it’s tooth missing for some time? Can bone that has filled the empty socket be drilled out for the post? Better asked, does an implant necessarily need to be grafted and installed at the time of tooth extraction or can it wait a year plus down the road? Thank you.

  92. Hello, very informative article – question, my second molar is fine but it is my pre molar tooth #14 (USA ) that needs to be extracted – would that tooth need to be replaced? Thank you in advance

    1. Isn’t that what he spends the entire article discussing? Do you want him to copy and paste the article as his reply to you?

  93. Hello.
    Let’s say I need my second upper molar extracted. Tooth 15. I still have my first molar as well as my lower molars(save for the wisdom teeth). Will I need to replace the extracted molar or can I live without it?

  94. How long does it take for the gum tissue to grow over a second molar extraction site after placing a bone graft and membrane for ridge preservation? I have other dental work that needs to be done that is not as urgent as the extraction ( removal of amalgam fillings in adjacent teeth) but I am concerned about the amount of time for the socket to heal over so no amalgam particles and associated liquids get into the open wound.

  95. Hi,
    I am 20 years old , and I just came back from the dentist who said that I have to get a root canal on my second molar #15. I was thinking if maybe it would be a better idea to have that tooth extracted since I still have my wisdom teeth. If I extract that molar, will my wisdom teeth move forward replacing the missing molar?

    1. very unpredicatble at your age. Maybe if you were 5 years younger. Ask your oral surgeon. He is going to depend on the position of your wisdom tooth in relationship to your second molar. Some of them are inclined and a very favorable position while some of them are not.

  96. Hi Mr. Ramsey, thanks for your article. I recently removed an upper second molar and no third molar behind. I want to know if I could experience any jaw problems or drfting teeth if i dont implant the missing upper second molar ? I’d be grateful to your answer.

  97. Hello!
    I appreciate your article and i have a question.
    I recently got my bottom 2nd molar (18) extracted 3 days ago and the other 2nd molar (31) extracted exactly a month ago. However, I still have my wisdom teeth halfway out of the gums. The dentist informed me that the wisdom teeth will close the gap in between the 3rd and 1st molars. How long do you think this will take? Is it safe or should I get implants immediately?
    Thank you for your time.

    1. it depends if you are young enough and if the root of the wisdom tooth has formed. Generally you would still need to be in your teens for this to work but sometimes it happens!

  98. Hi,
    I had my 2nd molar bottom patient left extracted and prepped with bone graft and membrane which will be removed 5 days ago (now 120hrs out from procedure)
    The molar was in bad shape – route canal with cap falling off 5 days before extraction. Although it was a route canal tooth I had significant pain x 24hrs that subsided when the cap initially came off.

    The procedure was done with a nerve block and was uneventful. Once the block wore off the pain was excruciating and I have required round the clock pain medicine for the last 5 days.

    While I imagine that is expected my concern is the significant swelling that remains which now includes a hard area ptotruding like a small golf ball. I saw dentist for a check yesterday and he felt it was as expected and to let it progress without intervention.

    Last night sleep was interrupted and the hard swelling has not improved at all with some new pain with opening my mouth (I am exercising my jaw gently to avoid it getting too tight).

    I have no fever, no redness, no signs of dry socket otherwise.

    I had cdiff from long term abx for a difficult upper implant in my past so to date have not been on abx for this procedure.

    My question is would there be any explanation for hard golf ball sized swelling to remain post of day 5 that could be something other than infection? Is it possibly just a normal reaction to the procedure and bone graft to that will settle in time and if so what is a reasonsble timeframe?

    My dentist is closed today and I am comfortable with Advil round the clock but need some understanding of expectations.

    I know you can’t give medical advice but would appreciate your expert toughts?

    1. this part is not good ….I had cdiff from long term abx for a difficult upper implant in my past so to date have not been on abx for this procedure.

      Read this post on antibiotics. You are likely infected internally. I always prescribe a yeast based pro-biotic to hep reduce chance of C. diff which is a bad thing!

      It may go away on its own but if infected in the bone you will lose the graft or it will be soft at time of implant leading to poor ling term prognosis if the implant that is placed into it.

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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.