Hi janie,

I was waiting for you to give an update and share a bit more info after your last 2 posts as there are a lot of issues going on with your dental situation. You have mentioned that you trust your dentist and that you feel he is good at what he does. That is fine but my feeling is that you may not have been fully informed by your dentists of the reasons for all of these complications. Which is not unusual as you can see just by the people who have come here looking for information.

Not having any x-rays to review, I can offer you my opinion based on your detailed description and my professional experience working chair side with oral surgeons, etc.

The first and most important issue that laid the foundation for the complications is the fact that the teeth had been had root canaled. Without question and irrelevant of physical symptoms, these non vital teeth were infected for many years. That is clearly evident based on the fact that you developed periodontal disease from the proliferation of the bacteria that originated inside of these teeth. I want to note here that this occurrence is typical of root canaled teeth and the progression of this infection can be seen on routine dental radio-graphs long before it becomes a severe problem. That is why you had different dental treatment to attempt to eradicate the infection and reduce the pocketing and bone loss. These treatments were unsuccessful because the source of the infection were the teeth and irrelevant of what was done, the bacteria residing inside of the teeth was going to continue to grow, multiply and spread beyond the teeth. Also, antibiotics may temporarily reduce the acute inflammation but the meds are not able to kill off the various species of bacteria that continue to multiply inside and outside of teeth.

Based on the information that you have shared here, the health of the bone and the floor of the sinus in that area of your mouth was/is compromised from the long standing infection. Placing a dental implant there was not only risky but likely to create a sinus perforation or at least insult an existing sinus perforation. Another reason to confirm that the site is still unhealthy is your statement about "the dentist not removing the gutta percha when he extracted the tooth for fear of damaging the sinus". This indicates that the bone was so compromised that instrumentation of it to remove the gutta percha could have resulted in additional bone loss and either perforated or further perforated the sinus making the placement of the dental implant impossible. So knowing that the gutta percha would be a chronic bacterial irritant, he chose to leave it so he could place the implant. It was a judgement call on his part. From a health perspective, leaving that gutta percha is the same as leaving a piece of infected tooth in there. I have seen this exact thing done many many times, so it is not unusual for a dentist to make that decision. However, down the road if you were to see a different dentist and he were to discover this retained gutta percha on an x-ray, he may very well have a different opinion on that being in there.

The other issue I feel you need more information about is regarding the dentists statement about the implant sealing the sinus perforation. There are a few things a bit skewed with that theory. The implant is a piece of metal that does not have the biological integrity to build cells to close the sinus membrane tissue together. A healthy membrane at the floor of the maxillary sinus is very thin like a piece of wet kleenex tissue but it is quite resilient. An unhealthy membrane, one that has been perforated by a foreign object and/or perforated from the bacteria of a chronic infection is not resilient and in fact very fragile. The dental implant is an irritant to the broken membrane and the perforation may or may not close around that implant because bacteria can migrate into that opening preventing it from closing. Sometimes a collagen membrane is placed inside the socket over the opening before the implant is put in if the dentists suspects there to be a sinus opening. The collagen encourages healing cells to close the sinus membrane. But it does not sound like your dentist anticipated an opening of the sinus and is still unsure if there is one. However, your drainage symptoms indicate a sinus perforation. The antibiotics may temporarily subside the symptoms... make the discharge clear... but that does not necessarily indicate that the problem is being cured.

I know all of this information is hard to read and can be a bit scary if not disappointing to hear "after the fact". But because you have sought information outside of what your dentist is giving you, I feel obligated to be straight forward with you and offer you as much information as I can in laymens terms. There are several other biological issues associated with your dental situation but the most important is the health risk from this being a chronic source of infection, which it has been for several years, is that the bacteria can migrate beyond the sinus and go into the brain. I know that is not what you want to hear but it is something to be informed about as you go along this journey with the dental implant.

You may have mentioned this but .... did you have a dental Ct scan of that area of your mouth prior or post op the placement of that dental implant?

Bryanna