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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

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

  1. 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.

  2. 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.

  3. 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?

  4. 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..

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

  6. 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.

  7. 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

  8. 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?
    Thanks

  9. 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.

  10. 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

  11. Great well written article!

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

  12. 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?

  13. 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.

  14. 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?

  15. 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

  16. 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.)

  17. 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?

  18. 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 🙌🙏

  19. 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.

  20. 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?

  21. 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?

  22. 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.

  23. 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.

  24. 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!

  25. 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!

  26. 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

  27. 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

  28. 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?
    Thanks

  29. 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.

  30. 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.

  31. 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

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

    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?

  33. 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?

  34. 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.

  35. 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.

  36. 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.

  37. 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!

  38. 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.