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Second Molar Dental Implant #18 with Extraction and Bone Graft

A failing root canal caused this.  The root canal was leaking and not done so well to begin with.  This is a lower second molar #18.  The opposite side would be tooth #31.  This is typically the last molar in the mouth on the bottom jaw.

Failing Root Canal
Failing Root Canal with Infection -3D scan



  • #18 molar pain when biting, crown loose, infection
  • Poorly done root canal
  • Vertical crack


  • Second molar restricted mouth access and longer implant needed if immediate can be done (told him 50/50 chance of immediate)  Other option is a socket bone graft and come back a few months later.
  • Minimal  bone to engage to immediate implant
  • Infection at the apex of the failed root canal.
  • Fearful patient!
Confirm Angle of Implant with drill


I will allow the implant to heal for 4 months, then I will make a custom abutment crown with ideal contours to prevent bone loss in the future.

Doing an immediate molar saved this patient at least $500 and did not lower the chance of success.

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

4 thoughts on “Second Molar Dental Implant #18 with Extraction and Bone Graft

  1. Hi Dr. Amin,

    I had an implant placed in the same area. After many attempts by my restorative dentist to make a crown (4 failed attempts due to crown too bulky causing raw/painful gums, crown coming loose due to fit, weird angulation even with custom abutment, crown with open contact, etc), the latest crown seems to be a lot better than all previous versions.

    However, the implant crown is really tight against my adjacent molar. It’s so tight that when I chew food, I can feel pressure in the 2-3 teeth to the right of the crown. I can only fit floss through with a lot of force and the floss shreds a bit. My dentist told me to give it a week to adjust because he doesn’t want to grind down the crown due to issues with open contact before. He also said a tighter contact is good for my long-term gum health. The tightness has gotten better when resting but I still feel pressure with every chew.

    My questions for you:
    1. Is this tightness normal/good for my adjacent natural teeth? I’m afraid the tight contact/pressure is causing my neighboring teeth to very slightly shift (hence the weird sensitivity/pressure when chewing – it kind of feels a bit like when braces wires are tightened).

    2. Is there any way to verify whether this crown is even a good one? I’ve lost trust with this dentist due to the many failed previous attempts at making a crown (he sent me away each time but I kept coming back with problems/complaints before he would address) but due to insurance issues, I can’t switch. I read your article about a crown with ideal contours — how do I tell if I have that?

    1. Of the tightness hasn’t resolved in a week then it should be adjusted. Often times they self correct if it is minor. If it can’t be removed then some “sandpaper “ can be placed between to relieve

      1. My crown is screw retained and is removable. However, my dentist insists on using sandpaper to lighten the contact. I don’t want any permanent changes be made to my natural tooth but my dentist insists that it is safe and won’t make a noticeable impact on the enamel.

        Should I let him do this or insist he remove the crown to do any adjustments in isolation?

        1. It is the right thing to do or you will have an open space that will develop over time. Slight adjustment of the adjacent teeth is normal and encouraged.

          Functioning of teeth causes microscopic interproximal wear and the teeth drift forward. For implants, you want to make as broad of contact as possible with adjacent teeth, especially the adjacent tooth to the front.

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