Expert: Joseph Zelig, DDS, D.ABP www.smileinthecity.com - 9/25/2006

Question
Thanks. I'm going to consider that procedure. In your experience, have you seen patients with noticeable facial collapse after losing 2-3 back teeth? My dentist told me that I would have to be missing at least helf of my teeth for any diference to show.

Also, you mentioned that the bone loss should stop once the implant is in. Why do I have to wait 3 months? Why can't an implant be placed sooner? Are the immediate placement implants riskier?
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Followup To

Question -
Thanks Dr, Would any, even minor, facial collapse be permanant? Or would implants correct it? My surgeon said I lost a lot of bone, and I needed a bone graft for the implant (and probably will need a bone graft and sinus lift for the other two ones). Also, can any procedure be done to fix any facial changes, even minor ones, due to tooth loss? It's made me self-conscious. Thank you again.
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Followup To

Question -
Hi Dr. I have two extracted teeth, both the last molars on either side of my mouth. One has an implant (no crown yet, though) that's doing
well. My second molar was extracted about 3 weeks ago. It will be replaced with an implant in about 3 months.

My friend said that she noticed that the side of my face where I had the recent extraction was slightly puffier than the other side (with
the implant). I also see lines around my mouth that I haven't noticed before, and my cheeks look a bit looser. Is this indicative of facial collapse due to bone reabsorption? Does it occur this quickly in your experience? Should I be concerned about changes in my facial appearance due to bone reabsorption while I wait for the second implant? I'm getting the procedure
done as soon as possible. Also, would implants correct this change in my face and restore it to what it used to look like? I'm concerned because I read that even missing one or two teeth can cause dramatic changes in the face. My first implant required a bone graft, and that side of my face looks stronger than the other side with the socket.

Also, at a checkup recently, my oral surgeon looked at the molar in front of the socket and said it should be evaluated before the implant is
loaded for the molar behind it. This molar in front of it had a root canal and apicoectomy, and was capped. There may be decay under the cap,
and it may have to be extracted. If that happens, I would get implants for both molars (#14 and #15 on the left side of my mouth) as soon as possible.   

If I have to go for several months with 3 missing molars (one has been replaced by an implant already), should I be concerned about my facial
profile changing? In your experience, would this wait cause noticable changes in one's facial appearance? Thank you for your help.

Answer -
Hi,
I don't think there is going to be much facial collapse in this short period, especially in the molar region where the bone is often thick to begin with. As far as the swelling, I would advise you to go to the oral surgeon and have him or her take a look at it. I agree that the tooth with the apicoectomy should be evaluated for residual infection which may cause future problems for the implant. I hope this info helps. Let me know if there is anything elsr I can help you with,

Best of Luck,
Joseph Zelig, DDS
www.smileinthecity.com


Answer -
Yes,
If there is facial collapse ("sunken cheecks") a good periodontist or oral surgeon can do a soft tissue graft to bulk out your gums. I have done this several times with very nice results. But make sure your surgeon has done this type of procedure in the past.
Best of Luck,
Joseph Zelig, DDS
www.smileinthecity.com

Answer
I agree with your dentist that losing 2-3 teeth usually doesn't result in facial collapse, but it's possible. Regarding the immediate implants, in a molar site the socket is not the right configuration for an implant right in the middle since molars have 2-3 roots and the implant should be placed in the middle where there usually isn't enough bone. However, there are people, including myself who place immediate implants into molar sites usually with bone grafting.

Joseph Zelig, DDS