I recently had #13,upper premolar, extracted,due to suspicion it had been damaged in a #14 extraction a yr ago (13 tooth and root looked OK, no infection, etc - so maybe tooth pain had been due to minute crack?) Dentist neglected to inform me that an implant could be placed at time of extraction. I did not read that this was possible until several days after extraction. Consulted an oral surgeon, who told me that the post he would insert would be at least 10 mm (the original root was 8 mm), and would be 1 mm below the sinus.
-I am uncomfortable with coming this close to the sinus: is it necessary to be this deep? This is a tooth that I do not chew with, and the tooth itself is small, why does the post have to be this long?
-CT scan showed bone density at 9 mm, I was told that minimum for implant is 8 mm (without using a bone graft, which I want to avoid) , so that I should have implant done asap if I wsanted to avoid bone graft (yet a periodontist I consulted refused to do the implant, 4 days after extraction, until at least three months had gone by, by which time I would have lost even more bone - why the difference between periodontist's planned tgratment and oral surgeon's)
-I asked if a mini implant could be used, since tooth does not touch in chewing (and no plans for such), and was told that would be inappropriate (why?)
Any response/insight greatly appreciated. June

Until our expert, Flossie, comes along I can offer this - my best friend had implants and the time line between removing the tooth and finalizing the implant was 3 months. She was told that the length of the securing device (screw) would be determined by general practice and procedure as well as her bone density and the placement of the implant.

Did you ask either the Periodontist or the Oral Surgeon why their opinions differed and why a mini implant would be inappropriate? They, of course, have your records and x-rays and we do not.

My personal preference when it comes to anything other than cleaning, filling (I have 2 fillings in my entire mouth) and maintaining teeth is an Endodontist because I have had two horrendous (and I don't use the word lightly!) experiences with Dentists attempting more complicated procedures. I am not "slamming" all Dentists, just referencing my personal experience.

The oral surgeon took the CT scan at his office and looked at it prior to telling me how long the post (or is it called an abutement?) would be, and told me what my bone density was at that time. He did not indicate that this was a determination to be made by my general dentist.
Bone loss will occur without a tooth or post in there, and that is why the oral surgeon wanted to get the post implanted right away (and, from my viewpoint, if the hole in the bone was still there from the extraction, why not use the same hole and not have to dig through fresh bone?)
I think this implant could be implanted right after extraction because this is a single root tooth. If the tooth had more than one root, as with molars, I think then that one HAS to wait those three months before ANYTHING can be done (and then, at that time , bone graft could be put in if bone density were low - and then that has to heal before the post is put in, I think)
My immune system tends to react to even benign substances, so I want the least amt of substances implanted into my mouth as possible (hence my desire for no bone graft, or as little as possible)
No, I did not ask either why their opinion differed. I didn't think of it until after the appts.
The periodontist is well known in this area for his work; the oral surgeon is not. June

Again, Flossie will have the answers. I don't know anything independently about the subject, only what I have researched, so what I "think" really doesn't matter. I know my friend has to have the extraction and then wait for the bone to heal before she can have the implant.

Have you researched this on the Internet?

There is a guide that most dentists who do implants use. It's what they use to determine what length of implant (post) to use. They DO have to take into consideration where the sinus sits when doing upper implants, sometimes a sinus lift has to be done to be sure it's not sitting at the tip of the implant.

Your premolars are used for biting and chewing so you want the implant to be long enough to support the daily wear on it.

You need to ask both of these specialists why they recommend the length of the implant they have and then make an educated decision which way to go. You really need to have ALL the information at hand to make the right decision for yourself. Write the questions you want answered down and make an appointment with each for a consult, take your questions in with you so you don't get home with any unanswered.

How did you replace tooth#14?

You are aware that once the implant is place you won't have a crown on it for a minimum of three months right?

To give you an idea of what I went through.
1. Trauma to tooth (upper bicuspid) when extracted for braces many years ago
1a. It wasn't known till later that the tooth decayed from the inside out
2. root canal performed and failed (roots are about 14 mm long)
3. 6 months wait before anything done
4. Implant placed
5. 6 months wait
6. Healing screw placed
7. 3 months wait
8. Gums grew over healing screw
9. Different healing screw placed
10 3 months later and restoration process started

There were a commedy of errors. The one I didn't like was not checking the side clearance well. After feeling like I had braces for a year.

Sinuses were a concern.

All things are fine. A dentist friend from gradeschool did the implant.