Expert: Rafael Mosery,D.D.S. - 12/24/2009

Question
I had a molar (#19) extracted one week ago because booth roots were vertically fractured and there was an infection underneath. Now, I have to choose between a bridge or an implant. I have a bridge on the other side for the past 10 years and I like it. Tooth #18 had a big cavity. The dentist warned me he may have to do a root canal on #18, but he was able to avoid it and do a big filing; I will need a crown on it. Tooth #17 is generally in good health, but has a small filling and small cavity. I was told by 2 dentists that I need a bone graft, maybe also tissue regeneration, before the implant. I am quite scared by the surgery aspect of the implant and the fact we will have to reopen my gum again and again. I have a keloid condition, will this be affecting the healing process? Can I wait to see if the bone will regrow by itself and let my gum heal first, then decide if I could do an implant if there is enough bone there? One dentist wants to do the bone graft and tissue regeneration in the extraction site as soon as possible to avoid bone loss. I don't feel comfortable with this idea as the extraction site is not even healed yet. I know that the implant in general will last longer than the bridge, but somehow I am more comfortable with the idea of the bone graft... Could I wait and see if the bone grows back before making a decision? And if ultimately I choose the bridge despite the advice from 2 dentists, am I making the wrong choice? I am a 38 years old female, in general good health.

Answer
I much prefer an implant over a fixed bridge.The fixed bridge is a compromise.The implant keeps the adjacent teeth to the space intact.At your age you would best be served by an implant.It would be ideal to have the bone graft after tissue closure about 5-6 weeks more.I would have preferred to have the graft at the time of extraction.Don't wait more than a couple of months to get this underway,after that the bone will start to lose volume in the site.Get the implant.