Angels,

The panoramic is 2D, 2 dimensional radio-graph. It does not show the detail like a 3D, 3-dimensional CT image. The alveolar ridge (bone that contains the root sockets) and the sinus area can be a bit skewed depending on the density of the patients bone and the position of the patients head when the xray was taken. Was your oral surgeon relying on panoramic xrays for the diagnosis?

How many actual THREE D CAT SCANS have you had? How many PANORAMIC xrays have you had and how many MRI's have you had?

Your ongoing symptoms indicate something is wrong ... and there is no reason for anyone to think you are making it up. Also, let me reiterate that your complications are NOT unusual for someone who had upper root canaled teeth removed and had a history of infection and sinus problems. Those teeth were causing havoc to occur in that bone and in the sinus for God knows how long before you actually had developed obvious symptoms or before the problems were diagnosed.

The findings on the CT by the ENT dr need to be further evaluated. Bone graft material should not resemble root tips unless the periodontal ligaments were not removed when the teeth were extracted. If the ligaments were not removed, then the ligaments would hold the graft material as if it was sitting in a cup and the cup would be in the shape of the root tips. This is not ideal because the ligaments are now dead tissue which could easily be harboring infectious bacteria. It is imperative to remove the periodontal ligaments in their entirety after the teeth are extracted to minimize post operative complications such as chronic infection and spread of infection.

Periodontal ligaments are live fibrous tissue that serve a few purposes but they are mainly there to protect each tooth and act like a rubber band around the circumference of the roots of each tooth to give it some flexibility. These ligaments also help supply the tooth with nutrition via the blood vessels. Once a tooth is extracted, the ligament looses all vitality and is nothing more than necrotic tissue that no longer serves any beneficial purpose.

The periodontal ligament can be compared to the after birth (placenta) in a pregnant woman. The placenta serves to protect and nourish the baby. Once the baby is born, the placenta serves no beneficial purpose and needs to come out or complications will occur.

All dentists are taught the importance of removing the periodontal ligaments at the time of a tooth extraction. They all know what can happen if the ligament is not removed. However, some dentists are either sloppy in the removal or they just don't bother removing it. Some dentists think the body will just miraculously absorb the ligament, which does not happen. Imagine an obstetrician being sloppy about removing a placenta or just leaving it in the women's uterus?!! As a noteworthy side ... when complications occur due to not removing the periodontal ligaments, those dentists who leave the ligament usually don't like to admit that they did that because it's a red flag that the job was incomplete. To make matters worse, their peers are reluctant to mention the ligament issue to the patient because they don't want to step on anyone's toes, they don't want the patient to go back to the dentist and be told something to the contrary or they just believe that that information should come from the dentist who did the surgery. When an ENT and an oral surgeon or 2 oral surgeons collaborate on a case, this is one of the issues they discuss without the patient being present.

The antibiotic injection that you had has likely reduced the inflammation and brought down the fever. This is not a cure, but it is a temporary relief... thank goodness for that!

Please consider what your next moves should be before you start making phone calls. Yes, you need to inform the oral surgeon who did the implants of the problems you are having so he notes them in your chart. If you don't inform him, he can say (at a later date) that you were content with the implant surgery because you didn't report having any further problems. However, I would hesitate to let him do anything further. I would not make light of what has been transpiring. When we feel relief, we tend to minimize what we've been through. Also let him know that you are deeply concerned about the ongoing symptoms and upset that you had to have more antibiotics. Let him know how you feel about this medication being a band ade and the actual cure for whatever is causing the symptoms.

You have to be careful how you present your words and emotions when you speak to any professional involved in this case. The last thing you want to be accused of is being overly dramatic or needy yet you seem content with the treatment that has been rendered to you. Do you understand what I mean by that?

Bryanna




Bryanna