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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

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.

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
Fellow – International Congress of Oral Implantologists

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

  1. 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?

  2. 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.

  3. 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.

  4. 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!

  5. 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!

  6. 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 😉

  7. 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

  8. 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?

  9. 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.

  10. 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.

  11. 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

  12. I’m having tooth 31 pulled. They strongly recommend an implant. What are your thoughts on pros and cons, please.

  13. 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?

  14. 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.

  15. 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.

  16. 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.

  17. 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!

  18. 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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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.