What do I need to know about dental implants?
May 6, 2015 10:28 AM   Subscribe

My root canal failed. Went to the dentist as soon as I started feeling pain, but the tooth is now unsalvagable due to decay and now an implant is my only option.

If you or anyone you know has had a dental implant especially on a molar, I would love to listen to what you know. I didn't quite understand when I got my root canal that it is not forever. Even in good cases most of them don't last forever and my case wasn't very good to begin with. There were a lot of things about root canals that I feel I didn't know until after I got one. In any case, since I haven't been given any other options (other than walking around without a molar). I guess I'll have to do it. It's so Expensive! How can I make sure it never fails? And what does it feel like to have one? And does the bone underneath build up? I'm asking that because I've read that when you extract a tooth the bone underneath weakens and shrinks due to there not being a tooth there anymore so I was thinking with an implant maybe it's the opposite and bone builds... so I hope my face doesn't look different if my bone structure changes. Do you floss it and brush it like a regular tooth?

I dunno. I'm freaking out a little bit here.
posted by manderin to Health & Fitness (22 answers total) 3 users marked this as a favorite
Yup, you don't even notice that it's there after it's implanted.

Implantation takes a couple of stages. For mine, they first "seeded" the area with some stuff that allows the bone to grow up a bit, to give something to screw into.

Next, there's a procedure where a titanium (I think) screw is placed into your jaw. That has to set for a few weeks, so the bone can grow around it and be strong.

Finally, they glue the implant over the screw. It's a custom-sculpted tooth to look and feel just like your tooth. If your dentist is fancy, they might even sculpt/create it right in the office.

The only really painful (and it was just a throb, really) part for me was when they put in the screw. Soft foods and some nice painkillers are the order of the day when you have that done.

The main pain, though, was the expense. It cost me a couple grand, all told, but my oral surgeon had a really decent payment plan. Ask about that before they have instruments in your mouth.
posted by xingcat at 10:43 AM on May 6, 2015 [2 favorites]

I have an implant to fill a spot where an adult tooth never grew. It's a lower first molar. I put it off for many years because of the expense and time involved, and but I'm glad I've done it. The process was expensive and took several visits, but the finished product is basically indistinguishable from the real thing. I eat with it, I brush it, I floss around it. The only difference I can think of is that gum around is maybe doesn't come up quite as high. That and as the years pass it looks whiter than the teeth around it as they stain and it doesn't.
posted by Lazlo Hollyfeld at 10:45 AM on May 6, 2015 [1 favorite]

In any case, since I haven't been given any other options (other than walking around without a molar)

Get a second opinion. I don't see any reason why an implant would be your only option. Other options may include partial dentures or a bridge. They are both less expensive and less invasive.
posted by Michele in California at 10:45 AM on May 6, 2015 [3 favorites]

I have an implant and crown on a maxillary canine that I've had for six or seven years.

The crown on top of the implant will probably have to be replaced, they told me every ten years or so. The implant itself might last for a lifetime. There is a special way that you floss the crown to get it clean as far underneath as possible but you otherwise treat it like a regular tooth. If you haven't been super serious about dental care before you, prepare to get serious-if you neglect it, you can have expensive problems.

It feels and looks like any other tooth.

You will want to have the implant done soon after the extraction because the bone will indeed weaken and shrink. In some cases, including mine, there is not enough bone to support the implant so they will do a bone graft, which adds additional cost and six extra months for the graft to heal and grow.

You can have a bridge instead of an implant and that is cheaper, but if you are younger and the anchor teeth are in good condition, it usually isn't worth the cost savings to permanently damage the anchor teeth.

Partial dentures are even cheaper, but obviously come with their own inconveniences.

A few years ago I had a new dentist who freaked out about the state of the implant and wanted to rip it out and do a bunch of other work. I got a second opinion from another dentist who said everything looked ok to him and that the implant looked like it had been extremely well done; I didn't do anything that the first dentist wanted to do and haven't had any problems. So I guess, be aware for a wide range of opinions about the implant once you have it in and be prepared to shop around rather than doing whatever some dentist wants you to do.
posted by Kwine at 10:53 AM on May 6, 2015 [2 favorites]

I have one implant, am mid-way through a second, and will require a third. I'm going to do the third proactively, rather than wait until the crown breaks off and I chomp on it in a restaurant. (I've been through this before and trust my dentist--all this stuff is a given, I'm not being fatalistic or anything.)

So. Implants. They cost a lot. You don't pay all of it up front. You get the tooth extracted, which is relatively cheap comparatively, and it takes a while to heal, like three months. Then you get the post put in. I had the option to pay that in two installments--I think most people pay on some level of installment plan, with some money prior and some money at point of service. I just paid it all together because I wanted the payment out of my way so I could go be anxious about something else. Then you get the post installed and you sit with that for three months. Then you get the crown. So the grand total is yikes but it's spread out over time.

Bridges: bridges compromise the teeth on either side. I think they are fine for some people but they're garbage for me because I don't tolerate crowns well, so I'd be sacrificing two more teeth for the needs of the poor tooth in the middle. If I hadn't had crowns on these teeth I'm replacing I wouldn't need to replace them (lackadaisical care in my twenties leading to root canals and generally compromised teeth.)

The first time this happened to me I had a good ol' fashioned freak out. The second time I just sucked it up and went with it. The third time I'm going into it by choice. All molars.

I don't notice the one that's finalized at all -- I have to think to remember which tooth it is. It feels like a tooth.

Re bone loss: they mix cadaver or cow bone with some of your own platelets, pack it in there at the moment of extraction or at a separate procedure, and that's the scaffolding the new bone grows on. You can look at it if you're a big weirdo. It looks pretty much like you'd imagine.
posted by A Terrible Llama at 11:02 AM on May 6, 2015 [3 favorites]

I opted to go with the "hole in my mouth" and I'm fine, but that isn't recommended for everyone. I can't get a dental implant because of other issues, but I was given the option of getting a "flipper" - a partial denture/retainer that is removable. However, I'm not at danger of other teeth moving around etc. just because of how my mouth happens to be configured. Go to another dentist to see if you have other options. An implant is not the only way to go, although it might be the best option for your particular situation.
posted by sockermom at 11:06 AM on May 6, 2015 [3 favorites]

Response by poster: I'm 29 if that matters. I'm starting to think this may have happened because I didn't floss my crown much. I was afraid it would come loose if I did. He showed me the x-ray where there was this grey cloudy spot around the gumline and said the good news is it hasn't spread yet, but he says that he figures I shouldn't put surgery off for more than a couple of months. In the mean time he's prescribed me an aggressive dose of antibiotics so that it doesn't get worse before my next appointment with an implant specialist (whom I haven't seen yet).
posted by manderin at 11:17 AM on May 6, 2015

I just got an implant recently. I lost the tooth six or seven years ago, after I damaged it in a fall. When they extracted the tooth, they put cadaver bone in where the roots had been, to help make a foundation for the screw.

It was years before I could afford to have the screw put in, and this had two negative effects: one is that the bone where the tooth had been did recede somewhat. One advantage of implants over other options like bridges is that having teeth and their roots helps prevent bone loss in the jaw and maxillary ridge, and I did have some. Last year, when I was able to get the screw put in, they had to build up the bone a bit, and so it cost more than it would have if I'd done it earlier.

The other negative effect of not having a tooth in that spot for several years was that the opposite tooth on my lower jaw erupted a little bit. Without the opposing tooth, it rose up just a little bit.

Once the screw was in, my oral surgeon said I had quite a bit of leeway in terms of when I got the crown put on. The screw being in place was doing its part to prevent bone loss. It was maybe a year before I had additional funds to get the crown put on.

One advantage of implants over bridges, besides preventing bone loss, is that they don't damage the surrounding teeth. Until I was looking into this, I never knew that adjacent teeth are partly ground down to create anchors for a removable bridge. My molars are in terrible shape, a mess of crowns and partial crowns and root canals, and my dentist really didn't want to mess with my teeth.

That said, I lived pretty well without a tooth in that spot for six or seven years. It was far enough back that people didn't notice it missing, and the biggest daily inconvenience was that the gap was exactly the right size for a cheerio to get stuck in when I was eating breakfast.

You do floss and brush the implant like a regular tooth. There is a kind of little indent where the crown sits on the gum, and every now and then something gets in there, which doesn't happen with real teeth that have roots. I've only had the crown on a week, and I already have stopped noticing it. Just feels and looks like a tooth.
posted by not that girl at 11:21 AM on May 6, 2015 [1 favorite]

I've had a molar implant for about ten years, and I'm about to get another. It feels just like any other tooth, has gum around it like any other tooth, looks like any other tooth. I don't notice or think about it unless I'm flossing - because the floss can slide further beneath an implant than a regular tooth. It's an expensive and annoying process, but since it's not a big deal once it's done.

Just a note that by "titanium screw in your jaw", xingcat means it sits in your jaw like a tooth without a crown on it. It's pretty small. I only clarify because the wording gave me Frankenstein images! :) Since it's a molar, it will only be visible if you open your mouth wide when someone happens to be looking at it from up close.
posted by kythuen at 11:21 AM on May 6, 2015 [1 favorite]

Just posting to agree with xingcat.
posted by harrietthespy at 11:39 AM on May 6, 2015 [1 favorite]

One of my front teeth is a crowned implant; though the implant process last year was nervewracking (will it hurt? will people be able to tell? will it be like a normal tooth?), it ended up being a bigger deal for me than anyone else, because I was aware of it all the time, but no one else could really tell, even when I was sitting next to them.

You've gotten a lot of good advice here, which I agree with. My one recommendation if you're concerned about cost is investigate having treatment done at your local dental college. It takes longer, but costs less, and the quality of treatment is generally high because the students are closely supervised. I did not do this because I was freaking out: "MY DENTIST KNOWS BEST AND IT'S MY FRONT TOOTH!" but knowing what I know now about the process, I would totally pursue the dental college option.
posted by deliriouscool at 11:45 AM on May 6, 2015

I effectively have an implant after having had a super-big root canal; it's more like, it's a crown that's almost the size of an implant. Everyone else has most of the main points, but I'll add a couple small "quirks that aren't serious but I wish someone had told me" things -

* The day I got the implant I spoke with a tiny bit of a lisp for the first few hours after it was in; nothing serious, though (I only even noticed it because I'd taken speech classes in college and I'm hyper-aware of that now). That went away after a day, and until it did I just sounded vaguely like Gillian Anderson which isn't necessarily a bad thing.

* I've noticed that I have to floss more diligently around it because it has a stubborn propensity to catch things in it.
posted by EmpressCallipygos at 11:49 AM on May 6, 2015

The Hubs had several implants done a couple years ago and is very happy with them. The main thing we learned was that if you have an extraction, make sure at that time, right then, have bone grafting material put in the extraction hole. Its a powdery stuff they cram down in the hole to make new bone. Then the socket will heal up and be sturdy and supportive. After that heals they put in the screw, a few months after that they do the crown part. Shop around. We traveled to Kentucky/Indiana to get the Hubs teeth done and it was worth the trip and the money.
posted by PJMoore at 11:52 AM on May 6, 2015 [1 favorite]

I have an implant and it was for a tooth that had a root canal done. The crown had broken and was replaced but bacteria got in under the gum and the resulting infection compromised the jaw bone. The most difficult and painful part of the whole process was having the original tooth extracted. The root canal was very well done and the tooth was reluctant to come out.

The process for me took a bit longer than normal because the infection had to be dealt with but once that was clear it went very smoothly. I can't even tell which tooth it is without tapping on it - implants are solid into the jaw bone and you can feel a difference when you tap on it.

You're expected to be gentle with it at first with regards to flossing and your dentist/surgeon might have additional instructions but I treat mine as if it were a natural tooth. As long as they do a good job of color matching on the replacement crown it will be indistinguishable from the rest of your teeth.
posted by tommasz at 12:37 PM on May 6, 2015

I had one done a few years ago and now can't even remember which tooth it is. If I'm supposed to floss differently (somebody mentioned above) nobody ever told me that. I went to an endodontist for the screw implant and a regular dentist for the cap. One problem along the way was that the dentist I started out with was apparently not at all proficient in fitting caps. He tried three times, and none of them were right. He had a solo practice, no hygienists, kind of old fashioned. And he gave up; told me he couldn't handle it. So I found a new dentist in a larger practice with all the state-of-the-art tools and experience, who made a fine crown. So the moral of the story is, don't try to save money with a small-time dentist.
posted by beagle at 12:53 PM on May 6, 2015 [1 favorite]

Response by poster: But I guess this means I can never get braces on my bottom jaw to straighten out my teeth there?
posted by manderin at 2:55 PM on May 6, 2015

I have a dental implant that is also a molar. I wouldn't say it feels Exactly like a regular tooth because when I chew I can feel my real teeth in a way that I can't really feel my implant. After all there are nerves in the real teeth and none in my fake one. However I am someone that has a pretty sensitive sense of touch/feel so I often feel things that others don't. I have no idea about the braces, but I really hope that's not correct because I too would like my teeth straightened.
posted by rancher at 4:14 PM on May 6, 2015

If you're considering braces, consider a consultation with an orthodontist before extraction. If you have tooth crowding, it's possible they won't even replace the tooth and may instead pull the other teeth together while straightening. While a different case, I had two teeth extracted before getting braces as a teen to alleviate potential overcrowding.
posted by mikeh at 4:29 PM on May 6, 2015 [1 favorite]

I had one for about 8-9 years and it was fantastic. I needed extensive bone grafting beforehand, which was obnoxiously expensive, but it held up very well until a period of severe illness last year, when it basically just fell out of my head. I'm getting more bone grafts now and will probably end up with an autologous one again (my own bone from somewhere else on my body) since that's what worked out the best previously.
posted by poffin boffin at 6:02 PM on May 6, 2015 [1 favorite]

In any case, since I haven't been given any other options (other than walking around without a molar)

You don't mention which of your molars is affected, but I opted to extract my upper right second molar rather than go through the expense, discomfort, and uncertainty of an extensive root canal. Six years later I can honestly say I've never regretted the choice. There's no way to make sure that an implant "never fails," and for me the utility of that one back molar wasn't worth the hassle. Obviously YMMV, but no one but me and my dentist can tell that I'm missing that tooth.
posted by little mouth at 6:09 PM on May 6, 2015 [1 favorite]

But I guess this means I can never get braces on my bottom jaw to straighten out my teeth there?

I think you need to talk to an orthodontist in addition to the surgical dentist but I don't get the impression there's a 'never' in dentistry. If your bottom teeth are just a teensy bit wonky, that's generally fairly charming. If they bother the hell out of you, and you're putting a permanent implant in, you should talk to the surgeon about that - that you want it in alignment with the place you want your teeth to be ultimately, not the 'natural' angle they might put it in now.

It's hugely mechanical, the whole thing. They're thinking of it in terms of 2x4's and we're thinking of it as 'dude, it's my fucking face'. But don't panic; I panicked like crazy and in retrospect I didn't need to, it was just my anxiety about this medical problem. No one else knew or cared except for Mr. Llama, who had to sit through countless hours of economic class analysis and the impact of that on motherhood. Fun times! If you get to escape that shit, just figure out on a calendar/Excel spreadsheet what your payment plan will be and go from there.
posted by A Terrible Llama at 6:48 PM on May 6, 2015

I have an implant as one of my upper front teeth. I've actually had some problems with it over the years, but am currently doing fine. The dentist that originally placed the final crown used too much cement, which unknowingly leaked out under the gumline and caused an infection (multiple times). So things can go wrong.

Even if things don't go wrong you have to be really diligent about maintaining excellent oral hygiene to prevent "damage" to the implant. A low-grade infection/gum disease around the implant can lead to bone loss, gum recession, and exposure of the metal parts of the implant itself (not as big of a deal for a molar). It can also harm nearby teeth. And removing an implant that is "ailing" can be really traumatic--it's not like they can just unscrew these things. Much of the time removal requires use of a trephine burr which essentially cuts around the implant and can cause severe defects in your jaw bone and/or devitalize nearby healthy teeth.

So I've had some problems with my implant, but I would do it all over again because it's otherwise awesome! Feels solid as a rock and a good porcelain crown truly looks identical to a natural tooth. I do have to floss way up around and underneath the crown--as in, the floss completely disappears into my gumline while I'm doing it. Yuck, I know.
posted by bennett being thrown at 3:54 PM on May 7, 2015

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