Why Dr. Motiwala?
- No Sinus Lift
- Single Visit
- Basal Implants
- Up to 80% Less Costlier
Pterygoid Implants - Cost & Procedure
Replacement of the Missing Second Molar
When a patient has missing molars or a missing second molar, the question arises whether one needs to replace the missing second molar. Most often, the patient avoids the replacement of the second molar because of various reasons. Most usually, the patient believes they can get away without replacing the second molar. Sometimes a regular dentist evades the option of restoring the second molar with dental implant, because of the absence of bone volume or bone density in that area of the jaw. But when the same patient has no teeth at all, the same regular dentist replaces even the second molars by giving dentures with 28 teeth - 14 teeth in the upper jaw and 14 teeth in the lower jaw.
Above x-ray shows a case in which the 2nd molar is replaced with pterygoid and basal implant
What if the second molar or back teeth are not replaced?
With missing molars, there is excessive loss of enamel due to overload on the remaining front teeth. Wearing out of tooth enamel leads to loss of vertical height. The loss of vertical height leads to the internal derangement of the temporomandibular joint. The video illustrates the problem of TMJ due to tooth loss and enamel loss.
What happens if you lose a molar tooth?
A missing molar causes the collapse of the adjacent teeth into the area of the missing molar. The rearrangement of the surrounding teeth leads to a loss of vertical height, as shown in this picture.
Reasons for restoring the 2nd molar
Do I need to replace the second molar? The following reasons are enough to convince that the second molar implant necessary for normal functioning of the jaws.
- Replicating nature
- TMJ is a Class-3 lever - The TMJ joint and the 2 jaws are analogous to a type 3 lever mechanism. In such mechanism the food bolus (load) should be ideally as near the muscle (effort) as possible for best mechanical advantage. If the food bolus is away from the molars near the premolars then that mechanical advantage is lost.
- Size and shape of the molars have evolved for grinding - The molars have a much larger chewing surface as compared to the rest of the teeth. The upper molars have 3 roots and the lower molars have 2 roots. This highly increased root surface area has evolved as these molars sustain high chewing forces.
- Complete dentures have 2nd molars – 28 teeth
- If a single 2nd molar is missing it is always replaced. Sinus lift is done to replace 1st or 2nd molar. 2nd molar should be replaced when full mouth dental implant reconstructions is being done.
Replacement Options for missing upper 2nd molar / upper back teeth
The options for replacement of missing molars are classified below depending on the amount of bone present at the site of the missing molar and the skill of the implantologist.
1. Short implant
Short implant for missing molar is a good and an uncompromised option if there is at least 5-mm bone for implant.
Cantilever bridges are made on front teeth or implants, wherein the hanging second molar is held as a cantilever. The front implants or front teeth take all the load. The bridge has to be made of a metal framework to take the heavy bending forces on the back tooth. In the long run due to heavy torque the porcelain chips from the metal and the front teeth or front implants fail because of compression forces. Most often second molars are not made and only the first molar is given as cantilever. Techniques using zygomatic implants or implants placed in the canine premolar region as in All on 4 rely on cantilever bridges to restore 1st molars.
3. Sinus Lift Surgery
Sinus lift surgery and dental implant takes several sessions and multiple surgical interventions for the replacement of upper missing molars. It takes 6 months for the bone graft and implant to heal before it can be crowned.
4. Pterygoid implant
Pterygoid implant is an ideal option for the replacement of missing upper second molars or back molars. Pterygoid implant is a type of basal implant. It engages the cortical plates of the pterygoid bone. This allows immediate loading of the upper second molar. There is no need of sinus lift and the crown can be fixed immediately in 3 days with PT-3D technique (Permanent teeth in 3 days(TM)). The pterygoid implant is placed near the second and third molar area in the upper jaw. Pterygoid implant prevents cantilever bridge because of its ideal position at the junction of second and third molar. Pterygoid implant has made sinus lift surgery obsolete.
How can the upper 2nd molar be replaced?
The only way of replacing the upper 2nd molar if the bone is less, is either by sinus lift surgery or by pterygoid implant. The following flow chart displays the different scenarios and the options available.
Pterygoid Implants Cost
Pterygoid implant is not only the best option to avoid sinus lift surgery because of technical reasons, but also the most cost effective alternative to sinus lift procedure. You can get an overview of the pterygoid implant cost in the below table.
Please take a moment to listen to what patients from around the world have to say about their experience with Dr. Motiwala.
Dennis (Sarasota, Florida)
Dennis shares his review 3 years post full-mouth dental implant procedure.
Joe Osga (Florida, USA)
Joe avoids sinus lift and gets full mouth restoration in a single visit.
Natalia Danilova (Brisbane, Australia)
Natalia gets NexxZr full upper arch Zirconia bridge on Basal implants.
Vincent Jones (Scotland)
Scotsman gets fixed teeth after wearing dentures for 25 years.
Pterygoid Implants Vs. Zygomatic Implants
Advantages of pterygoid implants
- Eliminates the need of sinus grafting.
- No cantilevers from front teeth or implants.
- Efficient chewing is possible as teeth up to second molars are replaced. In cantilevers and zygomatic implant cases 2nd molars are not replaced. If replaced then they are made as cantilevers which make the last implant weak and the bridge susceptible to fracture in the long run.
- Bone in pterygoid area is cortical in nature, and hence very strong and rigid allowing Immediate loading with a permanent crown in 3 days.
- Single piece implants are used which are strong in comparison to conventional dental implants.
- All patients who want dental implants in upper jaw are good candidates as bone is always available in pterygoid area.
- Flapless technique is used, as such patients have no swelling or bleeding and patients need not stop blood thinners, if they are taking any.
- Lifetime warranty given as strong single piece implants are being used in strong cortical bone.
- 100% success rate.