Infected Molar: What Implant Procedure is Best?

Evan asks:

I have a right side maxillary molar that was next to a wisdom tooth. The wisdom tooth was extracted ten years ago. The molar is now infected and has a large cavity in the back of it. I am planing on getting it replaced with an implant.

I am 45, very healthy, non smoker. I have looked at several different types and procedures on the internet but am not sure which is the best for me.

The main points I am debating are immediate loading vs delayed, and zirconian vs titanium. I would like to hear some pros and cons of both, to help me in my research. Thanks.

Answered by: Dr. David R. Edenbaum

Marlton, NJ

Hi Evan,

To begin, in the case of a maxillary second molar with an infection (periodontal or endodontic) I would, in my practice, and based on the literature, suggest a staged approach to replacement of the tooth.

The tooth should be extracted, the infection resolved, and the area grafted to ensure that no bone is lost. Following a period of healing, an implant may be placed and allowed to integrate without loading for several months. Then, the implant can be exposed. Ensure integration with an Osstell unit before restoration. Finally the implant may be restored. This staged approach to dental implants is less common today, but in an infected second molar in the maxilla it is still the most predictable.

As far as implant material, titanium has been used for many years and is well-documented and the long-term success rates are very high. With ceramic materials there is less of a volume of data. However, the data and systems that exist show very favorable outcomes. An important factor is the comfort level of your surgeon.

What works best in your surgeon’s hands may be the single most important factor in the success of your implant. Discuss your concerns and ideas with your surgeon. I am sure he or she will be open to a discussion with you. As clinicians we all appreciate a well-informed patient.

Best of luck.