Wisdom tooth & neighbouring molar dilemma

Declan1

I've had erupted impacted wisdom teeth on both lower sides for 15 years. Worst effect to date has been gum discomfort but nothing more.

Unfortunately the neighbouring molar on right side is now showing signs of decay and I had an ache in it a few days back. Have been to dentist who has put in a temporary filling for now.

I appear to have two options.
1. Surgical extraction of the wisdom tooth. Then attempt to fill molar. Dentist not optimistic. So probably end up with root canal. Again, not optimistic in the longer term so looking at an implant.
2. Pull the molar. Seems like a simple and cheaper option but I've bed told there could be complications down the line with moving teeth. Not possible to insert implant due to wisdom tooth. Benefit is that wisdom tooth will be easier to keep clean (it's sideways).

Any thoughts from anyone who's been through a similar issue? The thoughts of wisdom tooth extraction, filling, root canal, extraction and implant really doesn't appeal... Mid 30s. And not a dentist fan!

Oral Surgeon

You have many options, some good some bad.

If the adjacemt tooth is aching and your dentist thinks that it will need a rct then a simple filling is unlikey to work... The root canal and filling/crown after may also not work...

Depending on the condition of the adjacent tooth, the angle of the wisdom tooth and degree of impaction and your age/ general health etc....

No treatment- a bad option

Attempt fillings/root canals with no extractions- likely doomed to failure

Removal of wisdom tooth and try to save adjacent tooth, depends on the condition of adjacent tooth but often require root canal and a crown and have a poor long term prognosis as decay is usually deep behind the tooth....

Removal of the adjacent decaysed tooth and leave the wisdom tooth. Depends on the condition and impaction of the wisdom tooth but if its angled enough to cause that decay, then it is likely decayed itself and likely to trap food all on its own and eventually need removal

Removal of both wisdom tooth and adjacent tooth. If the decay is bad then this may be the best option. The extraction of this tooth must be real conservative of bone as you may want the option of an implant in this site afterwards...

The decision is yours.....

Declan1 wrote: »

I've had erupted impacted wisdom teeth on both lower sides for 15 years. Worst effect to date has been gum discomfort but nothing more.

Unfortunately the neighbouring molar on right side is now showing signs of decay and I had an ache in it a few days back. Have been to dentist who has put in a temporary filling for now.

I appear to have two options.
1. Surgical extraction of the wisdom tooth. Then attempt to fill molar. Dentist not optimistic. So probably end up with root canal. Again, not optimistic in the longer term so looking at an implant.
2. Pull the molar. Seems like a simple and cheaper option but I've bed told there could be complications down the line with moving teeth. Not possible to insert implant due to wisdom tooth. Benefit is that wisdom tooth will be easier to keep clean (it's sideways).

Any thoughts from anyone who's been through a similar issue? The thoughts of wisdom tooth extraction, filling, root canal, extraction and implant really doesn't appeal... Mid 30s. And not a dentist fan!

Declan1

Thanks very much for the input.

Agreed- it needs treatment and a simple filling ain't going to work.

What is the usual time between an extraction and implant? The filling & rct & crown seem to be aimed at just stalling the implant for a couple of years.

Would a future wisdom tooth extraction be simplified by the missing molar?

Oral Surgeon

Declan1 wrote: »

Thanks very much for the input.

Agreed- it needs treatment and a simple filling ain't going to work.

What is the usual time between an extraction and implant? The filling & rct & crown seem to be aimed at just stalling the implant for a couple of years.

Would a future wisdom tooth extraction be simplified by the missing molar?

You can place an implant into a reasonably intact socket immediatly if desired...

There is more going on here with the wisdom tooth extraction so I would recommend extractions and then implant later. I would generally wait for 2-3 months to allow soft tissue and bony healing, any longer and the bone may start to resorb away...

Having the 7 out may or may not make the wisdom tooth removal easier later. If you are planning on having an implant in the 7 soon then you should remove the wisdom tooth with the molar as it will be in the way of restoring the implant and the implant crown will then make the wisdom tooth removal more difficult...

I cannot stress enough how a careful extraction of the molar is needed or the site is gone.

Declan1

Thanks so much again.

One more question... Who is best coordinating all this for me? My dentist, or the oral surgeon or someone else?

Oral Surgeon

Declan1 wrote: »

Thanks so much again.

One more question... Who is best coordinating all this for me? My dentist, or the oral surgeon or someone else?

We like to promote a "restorative driven treatment plan" ie the person putting the crown on the implant plans everything...

In this case, I would say go to the oral surgeon first. Only see an oral surgeon who does implants (not all do) as he/she is going to make or break this plan. If that molar is taken out carelessly or destructively then there is no hope of an implant. Only the person who plans to place the implant will care about a careful extraction...