Here is my story: I’m a healthy female, 27 years old, and I have several small cavities, but until now, no other problems with my teeth. I hadn’t been to a dentist for treatment in 5 years. I finally went to the dentist this month. I got a couple cavities filled by the general dentist, but while attempting a root canal on my upper molar, #14, the endodontist said I have root resorption, which he didn’t realize beforehand when looking at the x-ray – it had appeared I just had a cavity very close to the root. So he said unfortunately he can’t save the tooth and it would need to be pulled and I’d have to get an implant. Several days later I had the tooth pulled, and the dentist packed some human cadaver bone in there and stitched it up as best he could. A week later I came back for a consultation for a dental implant, and this dentist said it’s too early to come up with an exact treatment plan, but I may not have enough room below where the implant would be, so they might have to shave down, or put a crown on my lower molar, #19. He told me to come back in 3 months to see how the bone graft is doing and possibly come up with a final treatment plan. His office assistants printed me a quote of the treatment cost and I was shocked and dismayed to see how expensive dental implants are, and also the possible additional expense of the crown on the lower molar. The dental implant procedure would be $3,460 for everything, and the possible crown on the lower molar would be $1,070. From researching online, I now know dental implants are in fact expensive, but I couldn’t help but feel they were trying to up-sell me on everything since I got there – I was never told of any other options for a missing tooth besides the dental implant, and I just noticed they also included a Sonicare toothbrush for $80 on the printed quote for some reason too.

Since I don’t feel they necessarily have my best interests in mind, I wanted the opinion of an outside party who has nothing to gain by giving me advice on my different options. So, some of the questions going through my head are: Was it necessary to pull the tooth in the first place because of the root resorption, or was the endodontist forced to pull it because he had already started the root canal and couldn’t finish it? Is a dental implant the best option for a single missing molar? What other options do I have? I want to preserve my remaining healthy teeth without spending a few thousand dollars on one tooth. How can I get a fake tooth in place that will help keep my jaw and other teeth structurally sound? I don’t care about cosmetic results because this tooth isn’t visible when smiling/talking. I know this was long, but thank you for reading, thank you for your website, and any help is greatly appreciated!
- Erin from San Diego

Erin,
External resorption, if it’s on the tip of the root, can sometimes be solved by doing the root canal treatment. However, it sounds like your external resorption was occurring on the side of the root, and there is no way we know of to fix that. There’s a destructive process in the tooth ligament that is eating away at the root. So yes, it sounds like the tooth needed to be pulled.

The fees you are quoting for the implant sound about right. The only thing I would question would be doing the crown on the opposing tooth. Maybe that’s necessary, maybe not. Another option is a bridge, which would cost in the ballpark of 3x the cost of a single crown, which figures out to only a little less than you’ve been quoted for the implant. I’m guessing that this lower tooth has supererupted because there is a lot of tooth structure that was missing on the upper molar they were working on.

I’d put up some resistance to that and see how firm they are in that recommendation. I would think they could adjust the tooth somewhat and have enough room for the implant.

But even so, I like to see that a dentist is willing to work with people who have budget issues. In your case, the dentist could suggest phasing treatment in this way: When you have an implant placed, part of the treatment involves a temporary tooth replacement – often this will be a flipper tooth that snaps in on a piece of plastic. Well, they could do that now and then start the implant in a few months, enabling you to spread out the cost.

Putting an $80 Sonicare electric toothbrush on your treatment plan sounds a little pushy to me. The Sonicare is a nice toothbrush, but you can get a nice manual OralB or Reach toothbrush for a few dollars, and some dental offices give them away, and they work just fine.

If you haven’t yet, mention your budget concerns to the dentist and see what kind of flexibility you get back from them–if they’re willing to work with you to try to make it affordable. If you don’t get a good response, try a second opinion.

But it is important to get to this soon – get something temporary in place of that missing tooth within 2-4 weeks – because the teeth on the sides start tipping in right away.

Response from Erin:
Thank you SO much for your response! I didn’t know I needed a temporary flipper in there right away – nobody told me that, they just told me to come in 3-4 months for the implant. I will definitely get that taken care of, and start saving money for the treatment – I’ll probably just end up getting the implant, since I don’t want to mess with the surrounding teeth to get a bridge, and risk those surrounding teeth getting cavities/needing root canals. And you’re right, the resorption was on the side, he showed me the tooth.

Other links:
Read more about the cost of dental implants.
Read the pros and cons of a dental bridge vs a dental implant.

My whole intend in choosing Clear Choice was to not have to worry about excusing myself from the table after I eat. I now not only have to do that I have to cary dental piks, dental floss and a tooth brush. There is so much food between the prosthetic and the gum it is uncomfortable and food sticks to the teeth everywhere. Also they do no follow up after the teeth are set, such as calling to see if there are any problems say after about two weeks. Perhaps this seems like a minor problem but it is huge when one is having dinner out in an upscale restaurant.
- Patricia from California

Patricia,
I know that the Clear Choice Center here in Phoenix has some capable professionals who have advanced degrees, similar to what you’re saying about California. I’m sorry that they didn’t explain the pros and cons of the various options to you. There are different options in full mouth dental implants. The full implant crown and bridge would have none of the problems that you are having with food catching under the prosthesis, because the implants are supporting individual teeth. The removable hybrid restoration or the implant overdenture would tend to be on the other end, where you would tend to have more possibility of food getting between the prosthesis and the gum, because there is a tissue replacement that laps over the gum. There are other options in between. Different people have different expectations of what they want with their teeth, and some professionals, unfortunately, seem to develop a one-size-fits-all approach.

And then that follow-up contact can be important because issues like this may be able to be resolved. If food is collecting between the the prosthesis and the gums, it’s possible that the prosthesis can be relined for a tighter fit. You may want to ask about that.

Other links:
Click here to ask the dentist a question.

Colton,
You usually lose your last baby teeth around age 12 or so, and then the permanent teeth erupt in their place. If you are age 16 and still have two baby teeth, it may be that you are missing some permanent teeth – that they never formed. This is a condition called congenitally missing teeth.

The most common congenitally missing teeth are the upper lateral incisors (not the teeth in the very front, but the teeth next over) and the lower second premolars.

When the permanent lateral incisors are missing, often the baby teeth will still fall out, leaving you with gaps. The gaps then need to be filled with some type of false tooth. This can be either with a dental implant or a dental bridge. If a dental implant is used, it is best to wait in placing that until bone growth has stopped, around age 18 to 20. Until then, some type of temporary tooth replacement, such as a dental flipper, can be used.

Another possibility is that the permanent teeth are impacted – they are present but their eruption is impeded. Sometimes an orthodontist teamed with an oral surgeon can help the tooth erupt into its normal position.

Mattie,
There is a possible problem with getting full dental implants placed the same day you have teeth extracted.

Some dentists will place dental implants into an extraction socket. The reasoning is that it’s easier and faster to place them when there is already a “hole” in the bone. The problem is that the tooth being taken out is often an infected tooth, and then that infection affects the dental implant and creates a risk of failure. Even placing implants in other places in your jaw while there are infected teeth nearby can increase the risk. In most cases, you would be better off having those last teeth extracted and letting all the infection clear up before having the implants placed.

Be very careful about choosing your dentist for dental implants. There is a wide range of differences between dentists in their success rates for implants, because there is a lot of pressure on them to trim costs, which means they try to cut corners. Cheap dental implants that don’t hold up over time can end up being very expensive dental implants.

It is possible to get dental implant surgery done in such a way as to allow the teeth to be placed on the implants immediately. That is called the “teeth in an hour” technique, and we have done that procedure. But there are increased risks associated with immediate loading, and if your dentist doesn’t share those risks with you, I’d suggest getting a second opinion.

Read more dental implants horror stories.

Link exchanges:

Kalamazoo emergency dentist Dr. Michael Sharp

One additional problem is that there isn’t enough space to fit replacement teeth in those spaces.

- Sun from Australia

Sun,
The “least invasive” way isn’t going to be the easiest, the least expensive, or the fastest way. But I can see where, if there is nothing wrong with your other teeth, that you would want to not alter those teeth if at all possible.

The first step would be to separate your other teeth to allow more space for the lateral incisors. This would require orthodontics. Be careful with this – you may end up with a general dentist who wants to move these teeth with Invisalign invisible braces. This is tempting, because it doesn’t require any metal brackets and it’s faster. But Invisalign doesn’t work well for a situation like this, because it would tend to tip the teeth. You need to have the roots well separated in order to fit an appropriate dental implant into each space.

Then, have dental implants placed in those spaces, allow those to heal, and then have crowns placed on those teeth.

The other good alternative, which is quite invasive, would be to do zirconium bridges replacing these front teeth. We have a case like this displayed on our website, where there were impacted canine teeth (see Jennifer’s zirconium bridge story). The adjacent teeth would be crowned, and they could be shaped so that the sizes of the teeth would be harmonious without requiring any orthodontics.

For more information, you may want to read our pages about the advantages of a dental implant vs a dental bridge.

I hope this is helpful.

Yvette,
Implants actually prevent bone erosion, or I would call it bone resorption. Yes, the gum will recede after a tooth has been missing for a couple of years, and your body will take the minerals from that bone and use them elsewhere in your body. But if a dental implant is used to replace that tooth, your body senses the presence of the implant and will not dissolve that bone away.

Having said that, that doesn’t necessarily mean that an implant is the best option for you for a tooth replacement. That depends on other factors, how much bone is left, where nerves or sinuses are, and other issues. That would have to come from a good examination by a dentist who has expertise in implant dentistry. If you don’t get implants to replace the teeth, then a bridge would probably work fine.

Links:
Read about the pros and cons of a bridge vs. a dental implant.
Read about facial collapse that occurs when you have lost all your teeth, unless they are replaced with implants.

What would be the best course of action from here? I want to get it extracted and possibly a new bridge. Dental implants would be the best option but they’re too expensive ($1800.00 per unit) and I would need two.

What would you recommend?

Thank you
- Bernard in New Jersey

Bernard,
So it sounds like you’ve been missing tooth #13 for some time, and that tooth was replaced using this bridge. If you had done the implant at that time, you wouldn’t have this problem now. That’s one of the disadvantages of a bridge. If there is any trouble with any of the teeth involved, you have to do the whole thing over.

If you do a bridge after #14 is extracted, it will be a four-unit bridge. That is riskier than a three-unit bridge, but many people do that and it works out okay. Especially if you have gum disease, that will be a lot of stress to put on the teeth that the bridge is attached to, which complicates gum disease. If it were me, I would go for the dental implant. I’m not sure why you need two implants. You can replace two teeth on one implant. But maybe there’s something about your case I don’t know that makes it so you have to have two implants.

I’m a big fan of saving teeth whenever you can. But even if your periodontist could remove the second root, that would leave this #14 very weak, and I’m not sure how long it would hold up.

Your case depends on too many factors that I can’t see or examine, so I’m not in a position to recommend a treatment for you. But I’m not sure you’re being given all your options, and would suggest getting a second opinion. If you don’t hear much different from the second dentist, then that will tell you that you’re probably getting the whole story from your present dentist.

I have some advice about second opinions—don’t give the second dentist any clues about what the first dentist said or about what you would like to hear until AFTER you hear their recommendations. That’s extra insurance that you’re getting an INDEPENDENT second opinion. That’s an important factor.

Other links:
Read more about dental implant options.

Becky,
A dental implant is certainly an excellent option whenever you have a missing tooth.

The main advantage to having a tooth replaced with an implant instead of a dental bridge is that you don’t have to grind down perfectly good adjacent teeth in order to replace the missing tooth. If those teeth need crowns anyway, then it tends to make sense to add the replacement tooth between them. It’s simpler. But if those teeth already have crowns and those crowns are working well, then having the implant avoids having to replace those crowns.

Related link:
Click here for more information about the pros and cons of dental implants.

I realize that I should get it removed. However, my question is about the effects of getting a tooth removed, and not getting an implant, but instead getting a removable ‘partial’. My dentist says that if I get only a “partial”, that my bone can receed over the years, and I can eventually lose the teeth on both sides of the extracted tooth area. Is that your opinion also? Do I need to get this implant, or will a ‘partial’ be acceptable? I am just a little fearful of getting an implant. Thanks for your help.
- Erica in Virginia

Erica,
You have three acceptable choices to replace a single tooth. A dental implant, a dental bridge, or a removable partial denture.

Yes, when you have a tooth extracted, the bone does resorb where that tooth used to be. But that doesn’t affect the adjacent teeth, only the space. If you have a removable partial, it will clip to those two teeth on either side and hold them in place.

A bridge is a much better tooth replacement because it doesn’t collect debris, it is much more comfortable (the hardware on a removable partial is uncomfortable in your mouth), and is more stable.

A dental implant is also an excellent tooth replacement. It’s nice because you don’t alter the teeth on either side of the space. But if you’re afraid of an implant, in many cases a bridge will do just as well.

 I’m suspicious of this dentist who says what you told me about a removable partial. The information appears slanted. And if he didn’t also offer you the option of a dental bridge, I don’t understand why.