Originally Posted by Bryanna

Hi jenny,

The oral surgeon did not necessarily do anything to cause a problem with the failure of the dental implant. The problem may stem from the fact that root canaled teeth are always chronically infected (irrelevant of obvious symptoms or not) and over time the infection depletes the proper formation of the bone cells and destroys the jaw bone in that area. In some of these cases, even when a bone graft is placed prior to the dental implant the jaw bone is not stable enough and the bone cells are not healthy enough to allow proper integration of the graft material. Sometimes this deterioration of the bone and non integrated graft can be seen clinically or radio graphically, but other times the problem is microscopic in size and not easily seen.

For the reasons I have offered you above, it is always risky to place a dental implant in an area of the mouth where there was a root canaled tooth. It is also risky to place one next to or in between other root canaled teeth.

The lower anterior (front) area of the jaw bone is anatomically thinner than other areas of the mouth... with the exception of the upper (front) anterior which is also thin. If you take into consideration the anatomical structure and the chronic infection, the risk of dental implant failure in those areas of the mouth is very high just due to those 2 issues.

The likelihood of achieving a successful integration of another dental implant in that area is slim but many oral surgeons will give it one more try. The risks of that are... infection and further loss of bone.

Options for replacing that missing tooth are if there are adjacent teeth:

1) A Nesbit removable partial which is a one tooth partial (similar to a lower flipper) but it may have a metal base that rests against a couple of teeth on each side of the space. These types of appliances are done for esthetics and space holding. They should not be eaten or slept with as they could become a choking hazard.

2) A Maryland bridge can be a single tooth permanently cemented appliance which would be cemented into small groves that are made on the adjacent teeth. Although this is cemented on, it can come loose with chewing and it can be difficult to clean interproximally (in between it and the adjacent teeth).

3) A permanent bridge could be 3 units. Two of the adjacent teeth would need to be cut down as anchor teeth for the 3 unit bridge. Those teeth would be crowned and the tooth in the middle would be a fake crown to replace the missing tooth. This type of bridge is cemented on to the adjacent teeth. Oral home care would need to be very good to avoid bacteria from accumulating around the margins of the bridge and migrating underneath the gumline.

You can ask the oral surgeon for a partial refund since he removed the implant soon after it was placed. You are likely to get that if you already have another treatment plan in place to replace the missing tooth.

Regarding the pain and discomfort that you still have... it would be normal to have that for several days post op. Keep rinsing with warm salt water 3 times a day and be sure to keep up with tooth brushing and flossing to minimize the food debris on your other teeth. At least until the area has healed, do not smoke or drink alcohol as both of these can prohibit the proper healing of the bone and surgical site and lead to infection. Refrain from using mouthwash as the chemicals in that are very irritating to the oral tissue and will not speed up the healing. Warm salt water is best.

I hope this was helpful to you.

Bryanna