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Oral Surgery/do extractions alter the face


I'm in my mid-40's. I had an extraction of #16 twelve yrs. ago, and #19 was extracted ten yrs. ago, and #15 looks like it will be extracted also.
Tooth 19 now is an artificial tooth that is part of a gold-onlay bridge (#18 and #20 are abutments.) Tooth 15 has extensive root decay and a severe furcation, so I doubt if I could get an implant there.
The onlay in #18 recently separated from the bridge and #19 is now held in place with the abutment tooth of #20. My dentist gave me 2 choices -a new onlay bridge (he says it will be more durable if it contains less gold and more palladium) or an implant in #19 and keep the existing remainder onlay in #20. Which do you consider the better option?
My concern is #15 will most likely be extracted and nothing will fill its space. Will 3 extractions change my facial appearance? In order to maintain a better facial appearance, should that weigh in my decision to have the implant in #19?

Hello Michael,

I don't think your facial appearance will be altered in any way. We are really talking here more about function than esthetics.
I don't have any X-ray to really advise you about the final option but I don't see any reason why you could not benefit from implant which is obviously the best option and your best investment on the long run. Even if the tooth has a severe furcation, there is always a possibilty for an implant with or without a local bone graft. Of course, I would have it done by an experienced surgeon who can offer you this kind of option.

All the best,


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Chawket MANNAI, DDS,Ph.D Diplomate ABOMS


I am a US board certified Oral & Maxillofacial Surgeon trained at UCLA and Parkland Memorial Hospital (Dallas) with more than 25 years of experience and will provide answers to all questions pertaining to the Oral& Maxillofacial Surgery region including Orthognathic Surgery, Trauma,TMJ, Implantology, tumour surgery (excluding cancer and Oral Dermatology),reconstructive surgery...


Extensive in all fields for the past 25 years hospital and office based.

American Association of Oral & Maxillofacial Surgeons American College of Oral & Maxillofacial Surgeons British Association of Oral & Maxillofacial Surgeons

2006: Mannai Chawket Early implant loading in severely resorbed maxilla using xenograft, autograft, and platelet-rich plasma in 97 patients. Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons 2006;64(9):1420-6. Bayonne, France. 1998: Bell W H; Mannai C [An interview with Dr. W.H. Bell and Dr. C. Mannai. Interview by Colette Orival-Demange.] L' Orthodontie franšaise 1998;69(1):225-9. 1988: Abemayor E; Zemplenyi J; Mannai C; Webb D J; Canalis R F The fixation of malar fractures with the transnasal Kirschner wire. The Journal of otolaryngology 1988;17(4):179-82. Division of Head and Neck Surgery, Harbor-UCLA Medical Center, Torrance 90509. 1988: Wald R M; Abemayor E; Zemplenyi J; Mannai C; Lesavoy M A The transoral treatment of mandibular fractures using noncompression miniplates: a prospective study. Annals of plastic surgery 1988;20(5):409-13. Division of Plastic Surgery, Harbor/UCLA Medical Center. 1988: Di S; Bell W H; Mannai C; Seale N S; Hurt W C; Taylor J; Waite D E Long-term evaluation of human teeth after Le Fort I osteotomy: a histologic and developmental study. Oral surgery, oral medicine, and oral pathology 1988;65(4):379-86. Division of Oral and Maxillofacial Surgery, University of Texas Health Science Center, Dallas. 1988: Bell W H; Mannai C; Luhr H G Art and science of the Le Fort I down fracture. The International journal of adult orthodontics and orthognathic surgery 1988;3(1):23-52. 1986: Mannai C; Schwartz H C Juvenile nasopharyngeal angiofibroma presenting as a facial swelling. A case report. Journal of maxillofacial surgery 1986;14(6):329-31. 1986: Mannai C; Leake D; Pizzoferrato A; Ciapetti G; Sangiorgi C Histologic evaluation of purified bovine tendon collagen sponge in tooth extraction sites in dogs. Oral surgery, oral medicine, and oral pathology 1986;61(4):315-23.

DDS,Ph.D Fellow and Diplomate American Board of Oral & Maxillofacial Surgery Residency training:Harbor-UCLA MedicalCenter 1982-1985 Fellow OMFS Parkland Memorial Hospital Dallas Texas with William H.BELL

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