Hi Bryanna, found this forum through Google and have a few questions regarding the dental implant process I'm currently going through.

My upper left front incisor had cracked about 3 months ago all the way up to the gum line. Prior to consulting with a dentist, I had been going to a corporate dental office near my parents and had decided to go to a smaller office where the wait time wouldn't be as long and the staff would "know" my dental care better. This dentist recommended I get a dental implant, since bonding was not going to work (the crack was too much) and the teeth next to my cracked tooth were healthy and shouldn't be ruined for a bridge.

Long story short, the tooth was extracted and the implant/bone graft was done immediately after. I was fitted for a flipper while we waited for the graft/implant to take to my jawbone and was examined in early December. The x-ray and examination showed I had a small infection and that there appeared to be bone loss at the implant site. The dentist immediately opened up the implant site to test the stability of the implant and said it was stable, despite the bone loss. He did another bone graft with synthetic bone (not sure what brand) that was in a syringe and told me not to apply any pressure to the area for 2 weeks, until the stitches can come out. He also said there was a lot of granulated tissue around the implant and used a laser for something but did not tell me what. I can now see a visible separation in my gum line where the implant is, but I cannot see the actual implant itself.

I'm on Amoxicilin for the infection (which I was not aware I had, since I had experienced no pain and saw no visible signs of infection), but I'm wondering what will be the next step when I see him in 4 days? He didn't have time to explain the possibilities to me, since another patient came in needing emergency oral surgery. Will I have to wait another 3 months after the stitches are taken out to see if the bone graft holds? If the graft doesn't hold, will he do another one or tell me I should just stick with the flipper?

Also, I did not get a second opinion after I found out about the infection, but this dentist does extractions, root canals, implants, etc. I don't think this is normal for most practicing dentists, should I be concerned that his work is maybe not being done with the level of specialization I could have received going to an oral surgeon who only does implants/root canals?

TIA!

Hi sammieee,

Welcome to neuro talk!

Firstly, you are very well informed. Either you have done some research or have been given very good information.

A few questions....... Do you have periodontal disease? Are either of the teeth next to the dental implant root canaled? Was the extracted tooth previously root canaled? Did the extracted tooth have a deep and/or old filling in it? Was that tooth decayed when it was removed?

Your answers may be helpful but I'll mention a couple of things now.......

Immediate load dental implants (implants placed at the time of the tooth extraction) need to be placed in very healthy bone with healthy bone surrounding the area or the area will become infected and/or the implant will fail. Generally when bone grafting is placed during an implant procedure, there is inadequate bone to begin with. This loss of bone at the time of the extraction could have resulted from that tooth being infected in which the bone had become mushy and had to be removed and/or there was periodontal disease and/or a forceful extraction was done which disturbed the bone more than it should have.

The granulomatous tissue around the implant can be indicative of a few different things... The extraction site may not have been thoroughly debrided which means there was inflammed (infected?) tissue left in there which attached itself to the implant.... And/or this tissue is a response from your own immune system which are referrred to as reactive lesions. These are formed in response to a localized trauma or irritation like the extraction and/or the implant. These lesions hold infectious bacteria and it is important to remove them or proper healing will not take place. However, they tend to reoccur for whatever reason and it might not be until months or years later. So anytime a dental implant is done, it is imperative to periodically evaluate it radiographically.

Infections occur for different reasons and they do not always cause pain until they become severe. So that could be why you had no symptoms. A good thing they took an xray.

There is always a concern about doing a second surgery in the site of the dental implant because any bacterial exposure to that implant can cause it to become infected and fail. There is a concern about reopening the area and adding more bone graft because this does cause contamination and the infection itself may or may not have been able to be removed depending on where it was in the socket. The amoxicillin has been given to you for not only the infection that was seen on the xray but for this second surgery as well.

Implants placed in healthy bone should integrate with the jawbone for at least 4-6 months before a crown or bridge is put on. It takes a year or better for that surgical site to heal completely, so half way through that year would be a good time to start the crown process. Disturbing the implant prior to that is very risky for long term success. Implants placed in questionable bone or resurgerized bone should be monitored with an xray once a month for 4-6 months post op the placement before any restorative treatment is done. To rush the restorative process can cause the implant to fail even under ideal circumstances.

So at your next appointment, your dentist should clinically evaluate the area, another xray may be helpful, he may remove the sutures, and that's it. It should be treated as if the implant was just placed for the first time.

If you get a chance, please send a repsonse to those questions. It may help tell the story a bit clearer.

Bryanna