Same-Day Extraction Immediate Lower Molar Dental Implants And Nerve Injury Discussion

Same-Day Extraction Immediate Lower Molar Dental Implants And Nerve Injury Discussion

Same-Day Extraction Immediate Lower Molar Dental Implants And Nerve Injury Discussion

Immediate Extraction and Implant Planning –deeply placed nerve.

It is not every day I see a case like this. This patient is going to lose her lower first molar which is the one that is second from the back typically if you are missing your wisdom teeth. It is the most common tooth to be pulled mostly because it has been in your mouth since you were 6 years old. In her case, the tooth is not savable because of severe root decay on an existing crown with a root canal. (Remember that you can get a cavity on a crown which typically happens at the edge or “margin” which is where the tooth meets the crown near the gum line.)

Decay in first lower molar root canal
Usually the lower molars require a “staged” procedure. This means that the tooth is usually extracted first in the implant is placed at a later date.

Most often, a socket preservation bone graft is done to prevent the bone from shrinking after the tooth extraction.

Because the procedure is done in stages, it typically takes 6-12 months to complete often based on how hard or soft your bone is or how fast or slow your bone heals.

What is so unique about her case is the depth of her nerve!! It is DEEP in the jaw! Most of the time, an immediate lower dental implant is not able to be done because this nerve is too close to the surface. Typically I like to place the implant a minimum of 1-2 mm away from the nerve. So if the nerve is high, your oftentimes limited to a short implant or an implant that cannot get enough stability when it is placed into a socket. This nerve gives sensation typically to the lip and chin. There are other branches of the third division of the trigeminal nerve that give sensation to the cheek and tongue.

The nerve is like an electrical cable which carries sensation back to your brain. If you’ve ever gone to the dentist and gotten your lower jaw numbed up, this is the nerve responsible for this.

By keeping a safe distance away from the nerve, an altered sensation or nerve injury complication can be reduced…. But not completely eliminated.  Complications can still occur with either method.

The nerve has several “tributaries” that are like in the fine fibers of a plant root system that you pull out. There is usually one main root and then thousands of little small rootlets. Most of the time as long as the main nerve is avoided, a nerve injury does not occur.

Plant roots —one main one and many tiny extra roots
If the nerve is bruised, you may feel like the numbness and last longer than normal. This is called a paresthesia. The numbness may last an additional 3 days, 3 weeks, 3 months or may become permanent.

It can be a feeling of slight tingling all the way to feeling fully numb. Most are temporary and return within about a month to full sensation.

It is my belief that this procedure should really only be done by a very experienced dental implant provider.

The advantages of same-day extraction/ lower molar dental implant:

  1. Decreased cost
  2. Single visit procedure
  3. Time savings of 4-8 months
  4. No need for socket preservation bone graft ( usually still need a “void” bone graft though which is much more minor)
  5. One time on antibiotics
  6. One sedation
  7. Virtually eliminates bone loss from disuse atrophy
  8. Ability to place a very wide diameter implant

The disadvantage of same-day extraction/ lower molar dental implant:

  1. Slight increased risk of nerve injury
  2. Lack of implant to be able to achieve primary stability
  3. Often the implant needs to be buried and later and covered with a minor surgical/laser procedure
  4. The tooth extraction must go smoothly
  5. Centering of the implant can be more difficult if not impossible

Nerve injuries can be prevented by a skilled/experienced dentist, intravenous/intramuscular steroids, L PRF/PRP blood product, a 3-D scan planned procedure.

This patient’s case is really cool because her nerve is a mile away! The implant is one of the largest available… A 7.0 x 13 mm which obliterates most of the socket. Obliteration of most of the socket works well to gain stability of the implant, reducing the need for bone grafting, and gives molars a hefty base for a good emergence from the gum line. It also helps carry the high bite force is the back teeth which is important to prevent bone loss around an implant-peri-implantitis.

Obliteration of the socket is not a good idea in other areas of the mouth such as the upper front where the implant should be placed closer to your tongue and the implant ideally be smaller diameter. The rules are very different from each area of the mouth to another… what applies in one area of the mouth can be disastrous and other areas of the mouth!

In some extreme cases that I treat, the nerve is so shallow that I have to move it out of the way in order to put implants in the jaw. This is called a nerve repositioning/lateralization

Plan for immediate extraction and implant. Deep nerve position.
After Immediate Implant –DEEP nerve.
Regular nerve position with dental implant

Same day extraction and implant of lower molars is a wonderful procedure. In my hands, it is very predictable and I have been doing this for about 20 years now as of 2017. It is only intended for probably about 10% of molars. It can be done on the upper jaw as well as the lower jaw. During the surgery, if I feel like there is any increased risk, I will generally abandon the implant and only extract the tooth with a bone graft. You have to be flexible and change if needed for safety and predictability.

The red lines drawn into the 3-D scan indicates the placement of the nerve.

I hope this helps you understand this procedure. The images showed the 3-D scan before extraction and implant placement and another limited field 3-D scan taken after the implant.

Ramsey A. Amin, D.D.S.
Diplomate of the American Board of Oral Implantology /Implant Dentistry
Fellow-American Academy of Implant Dentistry

20 Comments

  1. Jomi

    Hi. What’s the percentage chance of nerve injury of lower first molar?

    December 12, 2020 at 8:44 am Reply
    1. Ramsey Amin

      normal implant probably 1% or less.

      December 15, 2020 at 10:09 pm Reply
  2. Is there any way i could email you a copy of my cbct scan to see if my inmediate molar inplant was placed too close to the nerve? My regular dentist has passed away and would love some guidance on the on and off pain.

    August 13, 2020 at 7:41 am Reply
    1. Ramsey Amin

      Unfortunately the website does not allow this due to the potential for a computer virus. Any astute implant dentist should be able to evaluate this for you. The implant can actually be touching the nerve chamber and you have no problems at all. Each case is very unique. I actually do a procedure called nerve repositioning where I remove the nerve from the bone and put it back on the same day in order to place implants.

      August 16, 2020 at 7:46 pm Reply
  3. Peter Engels

    Dr Amin-I have found your comments to be thoughtful and well informed and wonder if you could answer a few questions for me. There are a number of people working on tooth regeneration-a few Dr Jeremy Mao, Dr Roland Lauster have said they have been successful in regeneration, but so far no public availability. Dr Mao’s post seems to resurface every couple of months but dates to 2010, their have been patents but no clinical trials. Dr Lauster also has patents, possibly clinical trials and says availability in 3-5 years from an article july 2019. Have they succeeded? Or is there really no progress other than the endless coming soon? On another question, down the road if I had dental implants for some molars I read conflicting stories that success is 95-97% but their are high chances of problems. The worst seems to be nerve damage. Using a experienced dental implant specialist and getting 3-d x-rays, cone beam scanning , seems to help, but I read that almost 44% have some kind of nerve damage because of the short pathway of bone and the proximity of the nerve. Can this possibly be correct? That seems like a number so high that it would not be a viable option. Your thoughts would be greatly appreciated and I thank you for your kind attention. Please email me at pen6589685@msn.com

    February 27, 2020 at 1:23 pm Reply
    1. Ramsey Amin

      44% is incorrect. It’s certainly less than half a percent! Tooth regeneration Is likely decades away from being reality in the regular dental 🦷 practice.

      Have your implant done right the first time by a skilled and experienced implant dentist. This will lead to the greatest likelihood that you will have no problems overtime. I have hundreds of cases that are already 20 years old doing great!

      March 4, 2020 at 6:28 am Reply
  4. Susan

    Dr. Amin, Thank you for your very informative website. I am 64 years old, female. In July 2016, I suffered nerve damage during a dental visit, followed by an infection, followed by endo in 20, followed by extraction of 20 a few days later and 18 about a week later. 19 was a pontic and 21 had been removed for orthodontia when I was a child. Augmentation surgery at 20-21 in Jan 2107, followed by full braces to turn 22 more front-facing. Augmentation surgery with donor bone did not work. My periodontist said the nerve at 20 is looping into 21 space. In addition, he says that he does not feel comfortable placing implants in 18 and 19 because I don’t have a lot of bone marrow there and he does not think augmentation will help. My general dentist does not want to do anything to the canine as it was stressed during the year of braces to turn it. I feel so discouraged and hopeless about all of this. Do you think I could be a candidate for bone leveling? I have good bone height, but not good width. Thank you for reading this.

    April 21, 2018 at 9:28 pm Reply
    1. RamseyAminDDS

      Bone widening is Generally much easier than vertical addition. In some extreme cases where the bone is not tall enough, nerve repositioning can be done.

      April 23, 2018 at 3:14 am Reply
      1. Susan Baker

        Thank you very much for your kindness in replying, Dr. Amin.

        April 23, 2018 at 9:50 am Reply
  5. Lana

    Dear Dr. Amin,

    What method/test would allow you to identify the location of the nerve in the jaw, as you described in your example above? My son had a root canal done on #30 that resulted in severe nerve damage and #30 extraction later on. We have been dealing with the consequences of that procedure for over a year now coming to the point of having a spinal cord simulator installed to reduce this facial pain. But none of the dentists has ever mentioned or offered to us any tests that could possibly show the location of a TN branch in the jaw. Thank you very much in advance!

    April 10, 2018 at 12:18 am Reply
    1. RamseyAminDDS

      I am sorry about your son. This nerve is very visible on traditional in office dental scanners. I don’t think there is a a way to test it since we all have it.

      April 23, 2018 at 5:05 am Reply
  6. Cynthia Pierce

    I am 63, female, had root canal on tooth 30 in 2010 by endodontist. He said I had 4 roots, instead of normal 3. Lost all wisdom teeth in my 20’s. I had a crown put on within a few weeks. Crown fell off in 2011, never fit right. I never replaced crown. Now dentist says I need an extraction. He did 3-D scan. Says I have 40% bone loss. I worked for Board of Dentistry in Florida for 3 years. Why do I need an extraction? I have no pain, am retired and widowed, live alone, but do have good insurance Cigna HMO and my cost is $600. Expert Maxio-Facial Doctor says implant $2000. Dentist said maybe a bridge instead as I have rear tooth. What is my best option or options here? Can I just get another crown? Please help me with this issue. I live on a very fixed budget, but my teeth are important to me. I had one previous root canal with eye tooth and temporary tooth that lasted 5 years. It cracked and permanent tooth put in. No problems. I live in SW Georgia. Thank you

    February 12, 2018 at 2:40 am Reply
    1. Cynthia Pierce

      Also, the dentist that made my crown in his office that fell off one year later said he would not see me again when I asked for my $1,200 refund. Thanks again

      February 12, 2018 at 2:48 am Reply
    2. RamseyAminDDS

      It sounds like you had a tooth saved that was on the fence of extraction instead. That would bother me also. I tried to guide patients not to try to do heroics on a tooth that has a poor long-term prognosis. Without seeing you of course there is no way that I could be certain.

      Getting another crown may end up with the same problem and more lost money. Have a second opinion but likely just remove it and have the implant done which has a very high success rate compared to a tooth that is being salvaged at all cost.

      sorry about your troubles

      February 14, 2018 at 11:02 pm Reply
  7. Michael

    In 2017, how long do the crowns on the implants last? I know this varies and the implant itself if done correctly will last a lifetime, but what about the crowns?

    August 21, 2017 at 8:48 pm Reply
    1. RamseyAminDDS

      Dental implants nor their crowns are permanent. Some do last a lifetime but if you get 20-30 years out of it many would call it a success. The crown and or the implant can be replaced if needed.
      The best advice I can give you would be to see somebody who is very experienced in this field.
      Unfortunately nothing lasts forever…not even us!!

      August 26, 2017 at 5:34 am Reply
  8. Wil chavez

    My Periodontist told me that because of my history of periodontal disease, I might not be a good candidate for all on 4/6/8 implants and full arches. I am 63 yr old male with 26 teeth and an average of 50% bone loss in my jaws. I have 2 molars that need to be pulled (one is abscesses) and 4 bottom front teeth are Very mobile with at least 70% bone loss. No history of any diseases including diabetes, I do not smoke or drink and have always been athletic. Based on this info, what do you think? I am torn but have been leaning towards all on 4 implants. I have been diligent with my oral hygiene for the past 34 years. My hygiene as an adolescent and hygiene was not good. I also wore braces in high school. My email address I southpaw123@cox.net. I have been exploring your website and also Dr Golpa in Las Vegas and have been to Clear Choice for a 3d ct scan and full consult.

    August 9, 2017 at 8:09 am Reply
    1. RamseyAminDDS

      I believe you contacted my office and spoke to Sophia already. Just because you had/have gum disease does NOT make you a bad candidate! It does mean that your case has to be handled differently during surgery and during tooth fabrication. Don’t be fooled by marketing.
      I look forward to meeting you to discuss further. 🙂

      August 12, 2017 at 1:48 pm Reply
  9. Bruce

    Son just had uppermolar removed and had bone graft what should he expect for healing process to look like and swelling how long and how long before he can start eating starting to panic he is getting scared

    July 11, 2017 at 12:26 am Reply
    1. RamseyAminDDS

      Having treatment only on one side makes it easy. Just chew on the opposite side during the duration of the few months that treatment is being done. Swelling and pain should be very minimal

      July 16, 2017 at 11:13 pm Reply

Write a Comment

Monica D.
Monica D.
December 29, 2020.
There aren't enough words (and I have a lot of words) to tell you how grateful I am to have found Dr. Ramsey Amin and his wonderful staff. I had an enormous amount of bone loss and I was hopeless after being treated by a different doctor for two years. I had multiple procedures such as gum graft, extractions, and a sinus lift. After all of that, the doctor released me and told me he could not help me any longer. He sent me to a large teaching hospital - who also had no idea how to help me. I was terrified and embarrassed. I had been missing teeth due to those procedures since 2017. That sent me out on a journey of meeting with no less than five different dentist/oral surgeons. Most of them shamed me for the bone loss and wondered what I had done to cause this. In reality, I had done nothing. The bone loss is my body's immune system fighting me, as well as hereditary traits. In fact not only was I having difficulty being able to have implants, I also had so much bone loss that I was also not a candidate for dentures. I researched "what to do when you have bone loss and can't get implants" and I found Dr. Amin's website. Then I researched him, read his reviews, watched every one of his You Tube videos. I called and got an appointment, and kept going to consultations with other providers. I had long since stopped smiling and being social. Missing teeth and the shaming was affecting my life so adversely. When I met with Dr. Amin for my consultation he was ready. He had all of my records and had already reviewed my scans. But more than that, he genuinely wanted to get to know about my life. He was/is authentic, kind and extremely professional with so much success and experience in difficult cases like mine. He worked up a treatment plan & I came back two weeks later to discuss my options...and the journey began. I have had three procedures under IV sedation, no pain, no narcotics needed for aftercare. Dr. Amin is a consumate, experienced oral surgeon who cares about your health & understands your fears. He communicates every step of the way and will provide you with all the information you need to make a decision to improve your health. I am still working toward my end goal, and we had to zig from traditional implants and zag to zygomatic implants instead...which is the reason I chose him in the first place. If there was nothing else that could be done to get me healthy & smiling again, I knew he would have that option to help me. And of course 2020, the year of CV-19. Don't worry, Dr. Amin & his staff follow all health & safety protocols. This review is long, because it is important you know my journey, so you might understand how fortunate I feel to be healing. I'm torn, because this place is like a great restaurant, I want to shout from the rooftops how great it is, how great he is. And at the same time, I want to keep this all to myself. I come 75 miles each way to see him. I know people travel from all over the world for his expertise. Do yourself a favor, have a consultation. You won't regret it. Dr. Amin is amazing and so is his staff.
Jennifer B.
Jennifer B.
December 18, 2020.
I cannot speak highly enough of Dr. Amin and his professional staff. I have to start off and say that I am absolutely TERRIFIED of the dentist due to several past experiences. I found myself putting this off for YEARS until I was referred over to Dr. Amin. I was petrified on my first visit... but he along with his WONDERFUL staff made me feel so calm and at ease. I had quite a bit of work that needed to be done, but we found the perfect plan that worked out for me, and I couldn't be happier. Words cannot express my gratitude to each and every staff member that made me feel safe and comfortable. Dr. Amin was always so attentive in asking if I was ever in pain... and I never was. These are truly remarkable individuals, and I'm so lucky to have a dentist that I can trust. I ABSOLUTELY LOVE each and every one of you! Thank you,
D M.
D M.
December 17, 2020.
I cannot say enough positive things about Dr. Amin and his staff. I originally found them on Yelp about two years ago. I needed an implant, front tooth of all places, and was extremely nervous not only about surgery but about how it would turn out. Let me just say I just adore the staff. Everyone is crazy friendly and the whole office has a very positive vibe. The staff is adorable and always has me smiling by the time I leave. They are all thorough and on-point about what they do, and I truly appreciate it. They are quick to respond to my emails no matter the question, and their appointment reminders are great too. Dr. Amin is very thorough and reassuring, and answered any questions my husband or I had. My regular dentist had questions about the procedure and Dr. Amin's office even reached out to them at my request (my dentist said they never received a call, but Dr. Amin's staff had date, time and notes - love the thoroughness!). After surgery the Dr. called to leave me a message about how it went. Very minimal pain during healing, never any pain during any visits. It took a few tries to get everything just right for the permanent crown (color, etc), but the end result is beyond fantastic! At one point during healing I thought I was experiencing some looseness or wiggling but unfortunately couldn't make it to the office. When I was finally able to make it in the Dr. was so relieved, bless his heart. Luckily it was just a false alarm and everything checked out ok. They're a bit further out from me, but I wanted the best. I sure found it! I wish they were my regular dentist, and I'm looking forward to seeing them again for my check-up which was delayed due to COVID.
Melissa E.
Melissa E.
December 9, 2020.
I found Dr. Amin a few years back after I hadn't been to a dentist in a decade. Many traumatic dental experiences in childhood have made me so phobic that even getting a cleaning was a knee-knocking, heart-pounding trial. But finally I couldn't put off some things any longer. During my first anesthesia session, Dr. Amin replaced five old metal fillings, and during the second he did three more plus a crown. I was completely comfortable, and never felt a thing. Because they were extra-long sessions, I did sleep for about 12 hours after, but the next day I felt just fine. This past week, my back top tooth cracked in half and fell out of my mouth, and a couple days later the crown on the remainder of the tooth fell out too! Despite being nervous about Covid 19, I had to get it taken care of, so I called and quizzed the staff about precautions, which turned out to be even above and beyond what I would have expected. So yesterday I went for the tooth extraction and plug. After they put on the blood pressure cuff and put in the IV, I gradually got a little tired and closed my eyes. I sat there for about 10 minutes and thought Gee, I wonder if they're going to get started any time soon, and a minute later Dr. Amin said "Wake up, you're all done!" That was a short session, and I didn't have the kind of fatigue I did my first time. I stayed up most of the evening. Today, everything is good! I'm taking my antibiotic and eating soft foods, and there is surprisingly little pain now that the numbness has worn off. The tooth site and my cheek are a little sore, and the corner of my mouth, and I have a very slight headache, but nothing to any great level--I'm not even taking the acetaminophen. I feel good, and wide awake. Thanks to everyone at the office for a comfortable and professional job! I really REALLY appreciate you for giving me painless dental experiences!
Tanya S.
Tanya S.
December 3, 2020.
What can I say about Dr. Amin he is the best! I'm so grateful for him. He has literally changed my life and given me the confidence to smile more. I had major restorative dental work done and everything went smoothly. Dr. Amin is very compassionate and he really cares about his patients he made me feel comfortable and cared for. He is very knowledgeable and has a great sense of humor. His office is very clean and they take the patients health and safety very serious. His staff is also amazing they made me feel very welcomed and important. I'm so happy I did my research and found Dr. Amin.  Thank you Dr. Amin and team.
Sheila S.
Sheila S.
November 6, 2020.
Two implants done! Finished all procedures and I couldn't be happier. It's the first time in years I looked forward to going to the dentist. Even during Covid life the staff and Dr. Amin took care of me. There is a possibility I may move to Long Beach but I would still travel to keep Dr. Amin as my dentist.
Allison S.
Allison S.
November 4, 2020.
I could not ask for a more caring, exceptionally knowledgeable dental care provider. He's not just a dentist, but someone who looks after your immediate dental needs and helps you plan and prepare for the future.
Julia R.
Julia R.
October 8, 2020.
I've been going to Dr. Amin since I turned 16 and have been going since. Before going to Dr. Amin's dental office, I had 4 crowns that I was not happy with and dealt with it until finally I asked Dr. Amin and because I  feel comfortable and because I trust him with his work I recently had my crowns fixed and worked on by  Dr. Amin and have never loved my smile the way I do now, I can actually enjoy my pictures, I can enjoy my smile from either angle and that really mattered to me. Thank you so much Dr. Amin still and will be in love with MY smile
Aaron D.
Aaron D.
October 6, 2020.
I've been coming to Dr. Ramsey for about five years and I have to say, he is by far the best dentist I've had - ever. The staff is professional and kind, the office is exceptionally well maintained, and Dr. Ramsey is careful and extremely knowledgeable about current developments and research in dentistry. I recently had a dental implant which was a long process but well worth it. I required a sinus lift as well as a bone graft. The surgery went off without a hitch, I was comfortable and the healing process was quick and without complication. Highly recommend!!
Flo O.
Flo O.
September 21, 2020.
This is my 1st review of Dr. Amin, and in my over 17 years of being with him, my experiences with Dr. Amin and his staff have always been positive.  I don't recall a bad experience with the several implant procedures i have had.  They run an efficient office.  I like that they are proactive and reach out to their patients to remind us of routine care needed.  Dr. Amin's bedside care is impeccable.  They are also technologically up to date in terms of sending out texts as reminders, ability to incorporate any appointment into your mobile phone.  That is certainly a plus.  Keep up the great care!!!