Hi N2LE,

Thanks for posting the xrays.

Clarify for me who did the extraction and the bone graft?

It is clear on these films that the bone graft material is only present in the upper portion of the healed socket. Whether or not the rest of the bone is solid enough for an implant is questionable.

When a tooth has a long term infection the bone is always going to be diseased. After the tooth is removed, the surgeon can only scrape away what he can physically feel and visually or radio-graphically see. It is common to leave microscopic bacteria behind. In some cases an antibiotic will be beneficial and other times the bacteria will continue to spread. It is imperative for the surgeon to remove as much as he possibly can and then evaluate the site before placing the bone graft material. If active infection can be seen and/or there is concern about residual infection, then the graft should not be placed in the site at the time of the extraction because it will fail and leave a void in the jaw bone. A short healing time monitored by your symptoms and radio-graphs would indicate when the site could be opened and graft material placed.

Removing a bone graft a year after it is placed is not easy to do and there is no guarantee that it can be removed in it's entirety.

I would suggest a consult with an oral surgeon explaining the history of the tooth, the root canal, the surgery and the post op pain. If he feels that this site needs to be surgically debrided, then perhaps you should consider having that done.

An oral surgeon is a different specialty than a periodontist and although they are both surgeons, they perform different dental procedures. Oral surgeons should be sought for the extraction of infected, root canaled or fractured teeth.

Bryanna

It was the periodontist who did the extraction and the graft although my regular dentist (who also does implants) was willing to do it as well. I thought I was doing the right thing by seeking out a well respected periodontist and not letting my dentist do it. I am going to see a prosthodontist who specializes in implants next week for a 3rd opinion. An oral surgeon I guess would have been preferrable but was the best I could do on short notice with no extra referral wait times (he successful did an implant for a family member so I was able to get a quick appt).
Can I ask what you're background is? Obviously you seem to know your stuff and are in the dental field...are you still practicing? Wish I had all this info going into this 10 years ago!
thanks again for your help

Hi N2LE,

A prosthodontist is a general dentist who has taken some additional training to acquire a specialty license in "esthetics and restorative dentistry". In short they focus on the "esthetics" of dentistry not the health of the teeth, the gums or the bone. This means that they cannot evaluate your jaw bone situation any more than your general dentist can. Also it is important to know that any dentist can take a crash course in implant dentistry and perform dental implant surgery. However, only an oral surgeon has the extensive education and experience in implant dentistry.

I think if you are concerned about the health of the bone which will determine if you proceed with the dental implant, then seek an evaluation by an oral surgeon first.

Periodontists are surgeons that focus on the health of the gums and surrounding tissues. They are the guys you want to see for the health of your gums. When it comes to performing other forms of oral surgery, extractions and implants, some periodontists are better at it than others. But when it involves an infected root canaled tooth with an extensive history your best bet is an oral surgeon if at all possible. Also, every dental case is unique to the individual and what works out well for one might not for another.

My background in dentistry spans over 30 years as a chair side assistant along with multiple other positions in general, perio, oral surgery and prosthodontic practices.

Bryanna