Hi jenny,

Just to be clear of what the oral surgeon meant by the term "rejection". The actual rejection is your immune system rejecting the chronic infection and the lack of vitality in the root canaled teeth. It has tried to keep this infection and inflammation at bay but it is no longer willing to do that. The formation of the cyst is what typically occurs with most root canaled teeth, irrelevant of how many times they are re treated with conventional or surgical root canal treatment. The "borrowed time" statement refers to the inevitable extraction of the tooth... but it also refers to that fact that you are playing a game of Russian roulette in that your immune system has already let you know that it's done dealing with this and now you are predisposing yourself to systemic health problems from the infection.

The upper anterior (upper front of the mouth) has a much thinner bone than the rest of the mouth. Once that bone is significantly damaged due to infection there is little to no bone to work with. Bone graft material is used to stimulate the body to grow new bone. It has to be placed "inside" healthy bone in order to stimulate those cells. If there is not enough healthy bone to place the graft into, then it can only be placed on top of the existing bone. This placement usually fails because the body rejects the graft as it can't figure out why it's there. Dental implants require the bone to be healthy, solid and adequate in height, depth and thickness in order for them to integrate with the bone. Anything shy of those requirements increases the risk of infection and failure.

Both root canaled teeth are unhealthy. Keep in mind they have been infected for 14 years beginning with the initial rc treatment, not just 2 years. One tooth may be more infected than the other but they are both on borrowed time. Removing the one and leaving the other means compromising anything you do with one or the other. Dentists will go along with removing just the one and then when the other acts up, the patient is floored that they have to go through more surgery and more restorative dentistry.

If you decide to do a bridge to replace #9 and you retain #8 rc tooth, it is only a matter of time before #8 needs to be removed which would mean not only more surgery but the fabrication of a whole new bridge.

I think it's important for you to be clear on the information that I have provided for you.

1) Discuss removal of both front teeth with your oral surgeon. Explaining that you do not want to have to address this area of your mouth again because #8 flares up.

2) Request of the oral surgeon that he remove the tooth in it's entirety along with the periodontal ligament and all diseased tissue and bone. I know that sounds wonky to have to make that request but not all dentists (including oral surgeons) automatically follow a thorough extraction protocol and if the patient presents that request, the dentist is more likely to make sure the steps are followed.

3) Express your concern about placing bone graft in infected tissue or bone. Ask the surgeon to be certain that the sites are healthy enough to receive the graft at the time of the extractions. Let him know that you are okay if he feels once he gets in there that it would be best to place the grafts a couple of weeks later. Again, I know this request sounds wonky but it really behooves you to make it.

4) Antibiotics.... yes most definitely discuss putting you on antibiotics starting 3 days prior to the oral surgery. This is enough time to reduce the acidity of the infection so that the local anesthetic (which is alkaline) is more effective.

None of this is intended to tell the oral surgeon what to do. It is just letting him know what your expectations are and that you are willing to comply with his decisions based on your concerns.

I know this is a scary journey to go on. It is much easier if you understand the treatment plan in it's entirety including both the oral surgery and the restorative options. Also, it is very helpful to plan your meals before the surgery date so that you can keep up with nutrition, etc without having to give it much thought afterwards. I can help you with that if you want me to.

Bryanna