Expert: Mark Bornfeld DDS - 8/1/2006

Question
hello, i may need to get a first molar extracted...and i wanted to know if i will need an implant...i would prefer getting orthodontics done to pull my 2nd molar into the position of the first molar...is this feasible?  my teeth are reasonably straight the midline is off by probably 2 mm, but that is it...thank u

Answer
Dear Wren,

Although it may be possible to orthodontically move your second molar into first molar position, this may not be the quickest, most painless, or most optimal technique for replacing the lost first molar.

First, keep in mind that it is quite difficult to move a molar tooth a full tooth position and maintain a vertical orientation-- more often than not, the second molar will be slightly inclined. There is also the risk of causing resorption of the roots of the molar with that amount of tooth movement, especially if you are an adult. The tipping and shortening of the tooth roots may well compromise the functionality of the second molar.

Also, be aware that the second molar is a functional tooth as well, so moving the second molar into first molar position still loses you one functional tooth position, unless you are also going to move the wisdom tooth into second molar position-- and wisdom teeth are unreliable teeth, if they are present at all.

So, although what you are proposing may be feasible, it is not likely to yield the best functional result.

That does not mean that an implant is the way to go, either. Depending on individual local anatomic factors, an implant may not be feasible-- for example, the main nerve bundle that runs through the lower jaw, or the sinus in the case of the upper jaw, may be situated in a place that would preclude optimal implant postitioning. In this case, it may be more appropriate to select a fixed bridge as a means of replacing the first molar.

You should discuss your options for prosthetic replacment of the first molar with your dentist. With his greater knowledge of your particular circumstances, he will be able to select an appropriate course of treatment.

Hope this helps...

Mark Bornfeld DDS
www.dentaltwins.com
Brooklyn, NY