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QUESTION: Dr. Tieg,I am getting tooth #19 lower left side, extracted. The tooth behind is already crowned and the one in front is not. What is best Implant or 3 crown bridge.? Is tooth 19 a molar or premolar? I am worried if I get an implant it will be where the nerves are, since it is the lower jaw. Thanks

ANSWER: Joe -  Let me tell you that the first molars, upper and lower, are considered the pillars of the bite.  These pillars support the bite and even the facial contours.  It is known that premature loss of these molars can cause a collapse of the bite, with secondary facial appearance changes.  Either the bridge or the implant will allow a stability of the bite and face.  So that is not a reason for either treatment.  The potential negative aspects of a bridge is that the teeth on either side of the missing tooth needs to be cut down to allow placement of the crowns on either side of the space to support the bridge.  The negative aspects of the bridge is the possibility of injury to the teeth nerves. Is that common? Not really, but it is a possibility producing the need for root canal treatment.  As long as the  teeth are not decayed and the previous crown was not that deep the chances should be small.  

As far as the implant, any surgeon who might place an implant needs to be careful and skilled.  Careful in that the doctor needs to know and make sure that he knows the depth of the bone before the nerve and also the width of the bone to support the implant.  If [planned well and done properly, there should be a successful placement of a dental implant.  If the implant is done properly and allowed to heal for, at least, four months before any crown is placed on the implant and the bite is balanced so no excess forces will be placed on the healed implant that implant can last a lifetime.  Also once healed cleanliness of the implant is important by brushing and flossing of the teeth.

In my experience, as long as the surgeon doing the placement of the implant is a board certified oral and maxillofacial surgeon and the dentist placing the crown is skilled, you should have no problems with the implant.  The implant will be better in my experience as long as the doctors are good and you keep the area clean.

If you have additional questions, feel free to contact me again.

---------- FOLLOW-UP ----------

QUESTION: Could you tell me if I choose the option to extract the tooth, and then do nothing, what complications may I face- pro's or con? Thanks

Answer
Joe - The main problem with leaving the area alone without replacing tooth #19 is that the tooth behind it, #18 will begin to tip over into the space.  The upper tooth that is biting into #19 will then begin to grow down into the space.  The combination can produce a complete shifting of your teeth and a collapse of your bite.  So simply, you will need to replace #19 afte it is extracted.

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Joel S. Teig, DMD, Diplomate ABOMS, retired

Expertise

I am a board certified oral and maxillofacial surgeon and I am available to answer questions related to tooth extractions, implant insertion, facial recontruction, facial and oral tumor removal, TMJ dysfunction and various successful treatments, including surgery if all else fails, and occlusal discrepancy requiring orthognathic or jaw surgery.

Experience

Board Certified Oral and Maxillofacial Surgeon practicine for over 20 years. Assistant Clincal Professor and State University School of Dentistry.

Organizations
American Dental Association, American Association of Oral and Maxillofacial Surgeons, American Board of Oral and Maxillofacial Surgeons

Education/Credentials
BA -University of Connecticut DMD - University of Pennsylvania School of Dental Medicine

Awards and Honors
National Honor Society (OKU), Philadelphia County Dental Society, Mosby Book Award, Oral Surgery Honors, Summa Cum Laude

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