July 2025 - Drake & Wallace Dentistry

I’m losing all of my teeth. It’s my fault. I know that and do not want a lecture about how it could have been prevented. My dentist already did that. My main problem is that he wants me to get bone grafting, wait months for that to heal, and then get the dental implants, then wait for those to heal, then get the teeth placed on top. I had a friend who got her dental implants and teeth the same day. Why can’t I do that?

Carolyn

Dear Carolyn,

All-on-4 Dental Implants

Please bear in mind that I haven’t examined you so I can only give you general advice. I’m a bit confused as to why you would need bone grafting if you still have all your teeth. There are a couple of possibilities. First, you may have severe, advanced gum disease that ate away at the bone. Second, you may have already been missing quite a few teeth and your dentist is just taking out the rest out to finish the extractions.

In some cases, it is possible to get teeth in a day with a procedure known as all-on-4 dental implants. This anchors the implants in a way that can avoid the need for bone grafting in some patients. Not everyone is a candidate, but it is definitely worth looking into .

Based on what I have read, you do not have a good relationship with your dentist. Getting dental implants, whether it be one implant, traditional implant supported dentures, or all-on-four, is an extremely advanced procedure. You not only want to have a great relationship of trust with the dentist doing it, but you want that dentist to have significant post-doctoral training in the dental implant procedure. There are countless dental implant horror stories from patients who did not have a qualified implant dentist do their procedure completely botch things. Some ended up with severe nerve damage. Others even lost part of their jaw.

So how do you go about finding the right dentist to do your procedure? The best implant dentists will be a fellow with the International Congress of Oral Implantologists (ICOI). To become a fellow has stringent requirements and you will be in safe hands with anyone who has met those requirements. I would schedule a consultation with one of them, let them examine you, then they can explain all your options along with the pros and cons. Each procedure has different benefits and potential drawbacks.

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I only have two wisdom teeth, both on my left side. Both are impacted. I’m getting the top one out because it is infected. The dentist gave me a few choices. He said that the bottom tooth is near a nerve. I can just take out the top one and leave the bottom as is until it becomes a problem. I can remove them both despite the bottom one being near the nerve. Or, I can remove the top one and just the crown of the bottom one, leaving the root. But, if it gets infected, I’ll have to go back and remove the rest. Do you have a recommendation? I’m almost paralyzed about this decision.

Emily K.

Dear Emily,

I’m glad you wrote. It’s hard when dentists do this to patients—leaving them to make the decisions without any real guidance. I don’t really recommend you leaving the tooth in place until it becomes a problem. You didn’t mention your age, but the older you get, the greater the risk of complications when it comes to removing wisdom teeth. The ideal time to do that is late teens to early twenties. After that your risk increases, doubling about every five years.

Because of that, I think you should remove it. What you don’t want to do is leave it and then end up with an infection and the need for emergency dental care when you have less control of the situation.

While nerve damage is a risk, it’s not extraordinarily high. With x-rays and careful work during the surgery there shouldn’t be a problem, though you can never completely get rid of the risk. While leaving the root is a viable option, I do not recommend leaving the whole root. Instead, just have him leave the root tip. That way the body won’t try to reject it.

The key will be allowing the dentist doing the procedure to decide during the surgery. It could be things are much easier than he first anticipated and it is very easy to remove the entire root with no risk at all. Or, he or she may get in there and realize that it would be safer to leave the root tip.

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