Bryanna-wow I found this site this morning and all I can say is that you have clearly helped so many people. Amazing. I am hoping that maybe you can help me. I have read dozens and dozens of your answers and found help in some of them, but nothing specifically on point. But you have provided me with a lot of helpful information and and idea of what I might need to do. Here is my issue. Please bear with me, it is a long story, likely 30 years in the making based on everything that I have read that you ahve written. I am 57 year old male, non smoker (reformed a few years ago!), in good health other than what I describe below.

In 1981 I had a root canal on tooth #10. The procedure was botched and became so badly infected that I ended up in the hospital with a massive infection, the pressure was so bad that it "blew out" tooth #10 and #9. I had a 2nd procedure to clean up the mess. I had braces as a teenager and my teeth looked pretty good, until this occurrence.

In 1994 I had braces put on again but my orthodontist struggled to get my top teeth to move into position. In 1995 while wrestling with my son tooth #10 was broken off at the gum line while the braces were still on. The braces were removed and I went to an oral surgeon for an evaluation. He discovered that the prior (1981) infection had caused the bones above #s 9,10, 11 to fuse, which of course was the cause of the issues in getting the top teeth to move. An apicoectomy was performed, the remains of tooth #10 was removed, and the bone fusion issues were addressed. The braces were put back on and I completed the orthodontic procedure. Then in late 1995 I had an implant to replace #10.

Then in December of 1996 I was diagnosed with Stage IV thyroid cancer. During the two years of treatment for that I was not allowed to use my retainer due to concerns about the retention of the isotope radiation in the retainer material. Of course this made all of the ortho work go to waste and my teeth mostly went back to where they were before the ortho work.

In July of this year (2012) I started to have pain in the area above tooth #10. My regular dentist noticed a possible slight loss of bone above this tooth, but saw nothing else on the xray. However he did note that the tooth seemed to have some mobility. He sent me to an implant specialist who put me on an antibiotic, gave me some pain pills and told me to "give it a couple weeks." After being on the antibiotic it improved but the pain never went away. The implant specialist then drilled out the back of the tooth, irrigated the area and replaced the screw, the head of which was totally stripped, forcing him to first close it up and order some special tools to allow him to get the screw out. He put me on a stronger antibiotic and more pain pills. Then over Labor Day weekend I was in so much pain that I ended up going to the hospital where they gave me an IV with morphine and put me on an another antibiotic and gave me morphine pills.

I then saw a new implant specialist in mid September and he performed an exploratory IV sedation surgery and discovered that I had a fistula that ran parallel to the implant post, it was filled with infection and upon cleaning it out he discovered that it ran all the way into the nasal sinus above tooth #10. His comment to the two assistants (one of them told me this later) was "S#%& I am looking inside of his nose." He did a bone graft to close it up and also bone grafted the area above the tooth, which had indeed lost some bone.

30 days after this first surgery the pain had not subsided, and I became constantly nauseated from drainage. A second more aggressive surgery was performed (on October 31) the fistula was reopened and enlarged, the implant was exposed and scraped, and new bone grafts were done to close the fistula and rebuild the bone surrounding the implant. Prior to this second procedure I had a dental CT, and a sinus CT, and an evaluation by an ENT. Other than the fistula nothing else showed up on either CT. No sinus issues, and not other dental issues could be found on the CT.

It has been two weeks since the 2nd surgery and while the surgical portion of the procedure is healing well, the pain and drainage continues. The area next to my nose above the implant and outward and horizontal to that is very sore and tender. My face is still swollen. I have a bad taste in my mouth and am nauseated most of the time. I saw the specialist yesterday, had the stitches removed, and he wants to "give it a couple more weeks."
In addition to this, I am convinced my top teeth have moved, I am slurring words with S letters and and I have what feels like pressure on tooth #9.

So that is the story and I am totally frustrated and have no idea what I should do next. My original assumption was the fistula occurred when the implant was placed. According to the specialist who found it, the fistula was 1.3mm in width, was perfectly straight, and tracked exactly parallel to the implant post. Although he would not come right out and say it, he led me to believe that the it was "man made." In other words that it was likely a pilot hole that was drilled for the implant, but the implant was then placed in a different spot and for whatever reason the hole was never properly closed up. However after reading much of what you wrote, I am not sure that this is the case, given that infection can cause a fistula. Not that it really matters I suppose at this point.

The implant specialist who did the two surgeries called my case "an anomaly," which did not give me a lot of hope that the issue has been resolved. I should also note that (as best as I can recall) recurring sinus infections and severe migraines began around the time of the original root canal (1981) and got even worse after the implant was placed. Over the past 17 years I have had more than 100 sinus infections, which have baffled my ENT because other than a slightly deviated septum (the narrow passage is on the same side as tooth #10) there are no other structural sinus issues that would cause the recurring issues. My problems have always been attributed to "allergies." So of course I took allergy shots for a few years but they did not help.

As of today the pain remains, the drainage remains, the nausea remains, the bad taste remains (any possibility this could be reaction to the temporary filling on #10 which has now been in for 4 months?). I have no idea what I should do next. Do I go to an oral surgeon for a different opinion? Having the implant removed seems to be the next option, but I guess I am not convinced that is the real issue. I would love to know your thoughts. This was a long post, but 30 years is a long time! Thanks.

Hi vahlbusch,

My first thought honestly ... get that implant out of there and do not replace it with another implant! How many of the other upper teeth were root canaled too?

Here is my take on the situation in a nutshell...

The original infection in #10 caused a bacterial infection in the jawbone. The root canal procedure caused further bacteria to accumulate creating so much deterioration in the jawbone that the bone basically became a bacterial mushy mess. The bone tries to rebuild itself but in the presence of bacteria it is just not possible. This bacterial mess travels through the blood vessels into the lymphatic system, eventually the endocrine system..... and the thyroid unfortunately catches all of it. When the thyroid becomes overwhelmed it cannot filter the bacteria out anymore. Did any of your cancer doctors ask about your dental health??

All of the dental procedures... grafting, apicos, more bone grafts.... that you have had done to "retain" this implant have not been able to restore the bone to a healthy state. So now the current offender has become the implant.

The ortho.... was icing on the cake. Orthodontia causes a great deal of chronic inflammation to occur within the periodontal ligaments that hold the teeth in the jawbone. Thus causing chronic inflammation in the jawbone as well. The ligaments holding in the root canaled teeth are diseased from the chronic bacteria coming from the infected/inflamed tooth. Remember, the ligament is the pathway of blood to the tooth to give it nutrition. When the tooth is root canaled, the nerves to this ligament have been severed so the tooth no longer receives blood. This not only causes the ligament to die but also sets up an ischemic response in the jawbone. Add to this the constant pressure from ortho on these dead ligaments and diseased bone....... the bacteria will continue to build up and spread as things deteriorate. Spread where... the sinuses and possibly further.

Your case is not an anomaly at all. If I had a penny for every time I heard a dentist tell a patient that nonsense. Your situation is quite logical when you connect all the dots.

I urge you to discuss with your dentist removal of that implant. Any chance you could post a current xray??

Bryanna