Hi Bryanna,
Have been reading your advice to many people and finding it helpful, hope you can help me with my specific problem (or if anyone else has similar experience and advice).
I am a mid 30's female with what I consider above average health. I have never had the flu, I get a cold about once every 5-8 years, I eat very healthy (no sugar, no grains, plenty of veggies and healthy fats and proteins), and avoid prescription drugs like the plague. I had a root canal done on my #22 tooth about 10 years ago due to a dens en dente situation that was causing the gum in the roof of my mouth at the root of the tooth to get infected. I remember going to an oral surgeon and getting a curettage prior to the root canal. The tooth was always a bit sensitive even after the root canal but all was good for about 7 years. Then in 2010 it got infected again and the root canal was retreated. I went to an endodontist the second time and was hoping the problem was solved once and for all.
In Feb of this year the area around the root of the tooth became infected again. The pain was not too bad but I knew something was wrong. I went to my dentist who put me on a 10 day course of amoxicillin and told me the tooth should be pulled. I am very skeptical of medical professionals in general and wasn’t convinced the tooth had to go since it had never had any decay and seemed to function great. I was also very attached to it given that it is a front tooth and I saw extraction as a last resort option (once they pull a tooth it is gone for good). The infection cleared up very quickly after the first few days of amoxicillin course and I was determined to boost my immune system and get my body resisting any subsequent re-infection of the area as best as I could. I was oil pulling with tea tree oil and flossing religiously to try to get the area clean.
Two months later in early April the infection came back and this time with a vengeance. I took a second 10 day course of amoxicillin which took about 5 days to kick in during which time the gum on both sides was badly swollen and I had intense pain all through the left side of my head (T3’s every 4 hours for 3 days barely putting a dent in it). The swelling on the inside of the gum went away quite quickly but the swelling on the outside of the gum above the tooth persisted for a long time with a big red ‘boil” evident. I could also feel tenderness on my face right up to my nostril so I knew the infection had traveled a long way. I was on the last day of the 10 day course and was worried that wouldn't be enough to clear it up properly. I went back to the periodontist for a followup and he gave me a “just in case” prescription of clindamycin. I waited a day or two using oregano oil and garlic on the gum (and taking it internally) and was happy to see the swelling and infection seemed to clear up so didn’t fill the prescription. At this point I knew extraction was my only option.
Two weeks after I finished the second course of amoxicillin (1 week ago today) I had the tooth pulled by a highly recommended periodontist who seemed to do a good job. He cleaned out all the infected bone tissue and put a bone graft in right away. He said the hole was quite huge but that the lower part of the bone around the jawline was still intact and all should heal well. He put me on 900 mg clindamycin for 7 days which I was very reluctant to take after just two weeks on the first course but did since he said it was very important to avoid infection from the graft. The next day I woke up and some of the bone graft material was weeping out of the wound, more troubling I noticed the same red boil just like I had when the tooth was infected on the outside gum above the tooth. The extraction site itself seems to be healing quickly but when I saw him yesterday to get my stitches removed and showed him my concern regarding the swelling above the gum his answer was YET ANOTHER course of antibiotics, this time amoxicillin for 7 days. I am VERY hesitant to take another course after just finishing the clindamycin yesterday (which gave me stomach pains every time I took a pill). I have been eating lots of yogurt and so far don’t see any side effects from the antibiotic (other than stomach pain) but I thought the extraction and cleaning of the necrotic bone tissue was supposed to solve things, what’s to prevent more and more re-infection in the future if I am still taking antibiotics a week after the extraction?

So my question is:
1. should fill this amoxicillin prescription or wait a few days and see if things clear up? I am very concerned about doing lasting damage to my gut flora. I took my last clindamycin pill last night and already the area is less tender and less swollen then it was yesterday when I saw him. Will the antibiotic work better if I attack it right away or is it okay to wait to see if I can avoid it altogether? Will the antibiotic even work? I read that bone graft regions can't be targeted by antibiotics anyway since there is no blood flow to that area until it gets incorporated as your own tissue.

2. how will I ever know if the infection is truly gone? from what I have read and what the dentist told me the area was likely infected for some time and there are typically no symptoms. I never had drainage so what happens to the bacteria in between antibiotic treatments...are they just waiting dormant ready to attack again? Does this mean he didn't clean all the tissue out properly? I am due to get an implant in 8-10 months but don't see how I am any further ahead than I was with my real tooth if the area in the jawbone remains infected?

Thanks you all in advanc for any advice you may have!

Hi N2LE,

First let me just clarify that although this tooth may have had symptoms on and off for a few years, the reality is that it has been infected for 10 years. Root canaled teeth do not get re infected... they remain infected. The nerve tissue that cannot be removed festers inside of the tiny canals irrelevant of how many times the tooth is root canaled. So for the dentist to keep prescribing antibiotics for an infected tooth that will undoubtedly need to be removed is nonsense. Your poor intestines!!!

I will repost your questions and answer in bold type.

<<1. should fill this amoxicillin prescription or wait a few days and see if things clear up?>>

THAT IS NOT SOMETHING I CAN ADVICE YOU ON. OBVIOUSLY THE DENTIST IS CONCERNED ABOUT THE FISTULA STILL PRESENT ABOVE THE EXTRACTION SITE AND ABOUT THE GRAFT FAILING. ONLY HE KNOWS HOW THAT BONE LOOKED WHEN HE WAS SCRAPING IT AND I ASSUME HE THOUGHT IT LOOKED HEALTHY ENOUGH TO PLACE THE GRAFT.

<<I am very concerned about doing lasting damage to my gut flora. I took my last clindamycin pill last night and already the area is less tender and less swollen then it was yesterday when I saw him.>>

I WOULD BE CONCERNED ABOUT THAT TOO! THE EFFECTS OF CLINDAMYCIN CAN STILL APPEAR WEEKS AFTER THE LAST DOSE. AT THIS POINT YOUR FLORA IS MESSED UP AND YOU REALLY NEED TO TAKE PROBIOTICS STAT TO TRY AND REPLENISH SOME GOOD BACTERIA. YOGURT IS NOT ADEQUATE AS IT IS HIGHLY PROCESSED AND MOST OF THE LIVE BACTERIA AT THE TIME OF PROCESSING ARE NO LONGER VIABLE.

<< Will the antibiotic work better if I attack it right away or is it okay to wait to see if I can avoid it altogether? Will the antibiotic even work? I read that bone graft regions can't be targeted by antibiotics anyway since there is no blood flow to that area until it gets incorporated as your own tissue.>>

YOUR IMMUNE SYSTEM SENDS OUT CELLS TO THE AREA OF THE INFECTION AND INFLAMMATION AS A NATURAL HEALING PROCESS. IN ORDER FOR THE ANTIBIOTIC TO REACH THE INFECTION IT HAS TO DESTROY THESE HEALING CELLS FIRST. IT CAN TAKE TWENTY FOUR TO FORTY EIGHT HOURS AFTER THE INITIAL DOSE FOR THAT TO START TO HAPPEN. SO THEN WITH EACH DOSE OF MEDICATION, MORE AND MORE OF THESE GOOD CELLS ARE DESTROYED ALLOWING THE MEDICATION TO REACH THE INFECTION. AS THIS IS HAPPENING, THE IMMUNE SYSTEM IS UPSET AND THE FLORA IS NO LONGER BALANCED WITH BENEFICIAL BACTERIA. THIS IS WHY IT IS ALWAYS HELPFUL TO TAKE PROBIOTICS SO THAT WE HAVE AN ABUNDANCE OF GOOD BACTERIA IN THE GUT TO BEGIN WITH AND THEN CONTINUE TO SUPPLEMENT WITH GOOD BACTERIA TO REPLENISH WHAT IS BEING DESTROYED DURING ANTIBIOTIC THERAPY.
WHEN YOU STOP THE ANTIBIOTIC, YOUR IMMUNE SYSTEM SENDS MASSIVE AMOUNTS OF HEALING CELLS TO TRY AND EASE THE IRRITATION IN THE GUT. IF YOU THEN TAKE ANOTHER ANTIBIOTIC A FEW DAYS OR SO AFTER YOU STOPPED THE LAST ONE, THE DETERIORATION OF THE CELLS BEGINS ALL OVER AGAIN. THIS MAY DELAY THE EFFECTIVENESS OF THE NEW ANTIBIOTIC.
IN ORDER FOR THE GRAFT TO INTEGRATE WITH THE BONE, IT REQUIRES A HEALTHY VOLUME OF BLOOD TO KEEP THE BONE VITAL. THAT IS ONE REASON WHY SOME DENTISTS ALWAYS GRAFT AT THE TIME OF THE EXTRACTION BECAUSE THAT'S WHEN THE BLOOD VOLUME IS PLENTIFUL.
THE ANTIBIOTICS DO REACH THAT GRAFT SITE AND THAT IS WHY THE MEDS ARE PRESCRIBED.

<<2. how will I ever know if the infection is truly gone? from what I have read and what the dentist told me the area was likely infected for some time and there are typically no symptoms. I never had drainage so what happens to the bacteria in between antibiotic treatments...are they just waiting dormant ready to attack again? Does this mean he didn't clean all the tissue out properly? I am due to get an implant in 8-10 months but don't see how I am any further ahead than I was with my real tooth if the area in the jawbone remains infected?>>

IT CAN BE DIFFICULT TO TOTALLY ERADICATE THE INFECTION IN THE BONE AFTER IT HAS BEEN THERE FOR MANY YEARS. THE BEST COURSE OF ACTION IS TO PLACE THE PATIENT ON ANTIBIOTICS... REMOVE THE SOURCE OF THE INFECTION WHICH IS THE TOOTH... DEBRIDE THE BONE CLEAN OF NECROTIC TISSUE AND BONE.... GRAFT THE SOCKET TO ENCOURAGE THE GROWTH OF NEW BONE.... MONITOR THE SITE ...... AND DON'T DISTURB THE SITE FOR SEVERAL MONTHS UNLESS COMPLICATIONS ARISE.

AS I SAID, THAT TOOTH WAS INFECTED FOR 10 YEARS. DURING THAT TIME THE BACTERIA MOVES BEYOND THE TOOTH INTO THE BONE AND THE BLOOD STREAM. THE ANTIBIOTICS AND RE TREATMENT TEMPORARILY REDUCE THE BACTERIA COUNT AND THE INFLAMMATION BUT NEVER CURE THE INFECTION. HOWEVER, THE BODY HAS MIRACULOUS WAYS OF DEALING WITH CHRONIC INFECTION AND IF YOU ARE GENERALLY HEALTHY YOU HAVE AN EXCELLENT CHANCE OF HAVING A FULL RECOVERY FROM THE INITIAL INFECTION.

YOU ARE MUCH FURTHER AHEAD REGARDING YOUR OVERALL HEALTH SINCE YOU HAD THIS INFECTED TOOTH REMOVED. NOW THE RECOVERY PERIOD BEGINS.

I REALLY CANNOT ADVICE YOU ON TAKING THE AMOXICILLIN OR NOT. ONLY THE SURGEON CAN BE THE JUDGE OF THAT BECAUSE HE KNOWS WHAT THE BONE LOOKED LIKE AS HE CLEANED IT OUT.

I hope I have been of some help, keep us posted ok ....

Bryanna

HI Bryanna,
Thanks so much for your reply, I really appreciate you taking the time to help everyone here.

To be fair to my dentists, they wanted to pull the tooth back in 2010 but I opted for re-treatment, then when it first flared up again at the start of this year I was told to pull it but ignored that advice because I didn't understand quite how the tooth just harbors this bacteria like I do now. It was when I got the second really bad infection in April that I knew it had to go. So the second round of anitbiotics was my fault for not dealing with it right away. At that point too is when the infection clearly spread much farther up into the bone.

The 3rd round I was put on after the tooth was pulled. So it seems the infected tissue wasn't quite removed properly during the debridement? My concern with taking this next course of amoxicillin is that the 2nd course of amoxicillin couldn't fully deal with the infection, then the course of clindamycin couldn't either (and this was once the tooth was gone), so why should I believe this third course of amoxicillin will? Am I wrong in assuming antibiotics only act to control the infection which will invariably come back (this is why we pull the tooth in the first place)? If antibiotics were capable of eradicating the infection I wouldn't have had to remove the tooth in the first place.

You said the bone graft failed....what does this mean? The graft area itself feels okay, it is above this region where the original infection was (closer to my nose) that the tenderness persists. If I take this next course of antibitics and the infection doesn't subside what would be the next possible course of treatment? What should I be asking my dentist? What exactly is a fistula? I don't have any drainage, so not sure what is going on?

I only buy artisanal non-processed yogurt and eat lots of it, am also on Florastor, so hopefully this will help. Since I finished the clindamycin 36 hours ago the area is already less swollen and less painful then it was when I saw my dentist, this same pattern happened before, can my own immune system take it from here?

Thanks again for your advice.

Hi N2LE,

I understand that you wanted to keep your tooth... but your dentists should have informed you of the risks of retaining this tooth in spite of your insistence on keeping it. They should have informed you that re treatment with a second root canal procedure would not cure the infection. That information "may" have prompted you to remove the tooth sooner and you wouldn't be dealing with any of this other stuff.

I don't recall stating that the bone graft had failed.??

You wrote:
<<The 3rd round I was put on after the tooth was pulled. So it seems the infected tissue wasn't quite removed properly during the debridement?>>

ME: The third round of antibiotics was given to you because there is no way to know for certain that all of the infected material and necrotic bone was removed during the extraction. The dentist can only remove what he can see and feel with the instruments. With that in mind, because the infection was long term and extensive, the periodontist is concerned that the graft could become infected so he's prescribed the antibiotic "just in case" there is residual bacteria. I cannot tell you whether you really need this medication or not.... only he can.

<<<My concern with taking this next course of amoxicillin is that the 2nd course of amoxicillin couldn't fully deal with the infection,>>>

THE SECOND ROUND OF ANTIBIOTICS WAS TAKEN WHILE YOU STILL HAD THE INFECTED TOOTH IN YOUR MOUTH. SO NO MEDICATION WAS GOING TO CURE THE INFECTION.

<<<then the course of clindamycin couldn't either (and this was once the tooth was gone), so why should I believe this third course of amoxicillin will? >>>

I ANSWERED THIS ABOVE. ALSO, THE DENTIST MAY BE THINKING THAT IF HE CHANGES THE ANTIBIOTIC FROM CLINDA TO AMOX THAT YOUR GUT MAY NOT REACT TOO SEVERELY. ALSO AMOX IS FREQUENTLY GIVEN MORE SO THAN CLINATO PATIENTS WHO HAVE EXTRACTIONS AND BONE GRAFTS.

<<<Am I wrong in assuming antibiotics only act to control the infection which will invariably come back (this is why we pull the tooth in the first place)?>>>

YES, YOU ARE MISTAKEN.
1) ANTIBIOTICS CAN KILL THE BACTERIA THAT CAUSES INFECTION. SO LONG AS THEY CAN REACH THE INFECTION.

2) THEY ALSO NEED TO BE THE PROPER ANTIBIOTIC TO BE ABLE TO KILL THE PARTICULAR BACTERIA THAT IS CAUSING THE INFECTION. BROAD SPECTRUM DRUGS LIKE CLINDA AND AMOX ARE GENERALLY USED IN DENTISTRY BECAUSE THERE ARE SEVERAL SPECIES OF BACTERIA THAT CONTRIBUTE TO AN ORAL INFECTION.

3) ONCE THE SOURCE OF THE INFECTION HAS BEEN REMOVED, THEN THE ANTIBIOTICS CAN CLEAN UP THE RESIDUAL BACTERIA THAT IS MICROSCOPIC.

<<<If antibiotics were capable of eradicating the infection I wouldn't have had to remove the tooth in the first place.>>>

AS I'VE WRITTEN ... THE ANTIBIOTICS CANNOT GET INSIDE THE DENTIN TUBULES (MICROSCOPIC CANALS) INSIDE OF THE TOOTH. SO THE TOOTH REMAINS INFECTED IRRELEVANT OF HOW MANY ANTIBIOTICS YOU TAKE. SO THE INFECTION JUST CONTINUES TO PROLIFERATE THROUGH THE TOOTH INTO THE JAW BONE. AS LONG AS THE TOOTH IS PRESENT, THE INFECTION WILL BE PRESENT.

<<<The graft area itself feels okay, it is above this region where the original infection was (closer to my nose) that the tenderness persists.>>>

YOU HAD STATED THAT YOU HAD A "BIG RED BOIL" ABOVE THE TOOTH. THIS IS CALLED A FISTULA AND YES THE BACTERIA DOES DRAINS THROUGH THIS FISTULA. WHEN THE INFECTION SPREADS INTO THE BONE IT TRIES TO FIND A WAY TO RELEASE THE PRESSURE FROM THE INFLAMMATION. SO THE BACTERIA BURROWS A HOLE THROUGH THE BONE UNTIL IT REACHES THE GUM TISSUE AND THAT IS WHERE IT FORMS A PIMPLE (FISTULA) ON THE OUTSIDE OF THE GUM. THE TENDERNESS YOU FEEL COULD MEAN THAT THERE IS INFECTION STILL IN THAT AREA. IT COULD ALSO BE CAUSED BY THE TRAUMA TO THE BONE FROM THE INFECTION AND ALSO FROM THE SURGERY.

<<<If I take this next course of antibitics and the infection doesn't subside what would be the next possible course of treatment?>>>

THE DENTIST WOULD PROBABLY REMOVE THE BONE GRAFT AND RESURGERIZE THAT AREA TO OBTAIN A GOOD BLOOD VOLUME. THEN THE SITE WOULD BE CLOSED UP... MORE ANTIBIOTICS WOULD BE GIVEN....IT WOULD BE MONITORED.... AND SOMETIME IN THE NEAR FUTURE IF THERE WERE NO FURTHER COMPLICATIONS, YOUR SYMPTOMS WENT AWAY AND RADIOGRAPHS SHOWED A HEALTHY SITE HE MAY ATTEMPT TO PUT IN A NEW BONE GRAFT.

<<< What should I be asking my dentist? What exactly is a fistula? I don't have any drainage, so not sure what is going on?>>>

YOU SHOULD LET HIM KNOW THAT YOU ARE NOT TAKING THE ANTIBIOTICS AND THE REASON WHY. AS I'VE WRITTEN, HE KNOWS WHAT WAS PRESENT WHEN HE DID THE EXTRACTION AND HAS HIS REASONS FOR PRESCRIBING THE ANTIBIOTIC. I CANNOT TELL YOU IF HE DID THAT JUST FOR A PRECAUTION OR BECAUSE HE FELT IT WAS NECESSARY. I EXPLAINED THE FISTULA ABOVE. IF THE FISTULA IS STILL PRESENT OR EVEN THROUGH THE SURGICAL WOUND YOU MAY BE HAVING DRAINAGE AND NOT KNOW IT.

Sorry this is in small and big letters... hard to differentiate between your post and mine. Hope I did that okay ...

Bryanna

Hi Bryanna,
I should have psoted an update earlier but all was going well. Now I have some concerns. The amox course that I took after the clindamycin post extarction and grafting finally seemed to clear up the infection and the site seemed to be healing normally after that. After my 4 month followup though I started to get some sensations in the area of the missing tooth which were a bit troubling. At the time the perio said the x-rays looked like things were filling normally. Today I just had my 7 month follow up and it doesn't seem like things are progressing. Dentist told me normal wait time for implant post bone graft is 4-6 months so I am already past that point. I know I lost a good chunk of graft material post-op with the infection causing it to ooze out, but because of the sensitivity I sometimes feel in the area I am convinced the infection is still present.
He also told me today that after 10 months the bone graft will be as good as it's going to get. Didn't have a chacne at the time to ask all the questions I wanted so hoping you ahve a second opinion.
1. If the area is still infected (even though no obvious outward signs) will taking MORE antibiotics fix this or is it unlikely? I already took 2 back to back courses post-extraction which should have done the job
2. If the bine density isn't sufficeinet in 10 months time what are my options then?

Will call dentist with these questions too but always nice to get more opinions!
]Thanks

Hi N2LE,

Nice to hear from you!

Something you wrote is very concerning to me. You wrote:
"I know I lost a good chunk of graft material post-op with the infection causing it to ooze out, but because of the sensitivity I sometimes feel in the area I am convinced the infection is still present."

1) If the bone was visibly infected much beyond the tooth itself at the time the tooth was removed, the bone graft should not have been put in. The surgical site should have been debrided (scraped) very thoroughly, irrigated with copious amounts of saline and then sutured closed. Antibiotics would be prescribed for a minimum of 10 days and perhaps another course or two after that. The reason being is that the graft material would not be able to integrate properly with bone that has an active infection. The antibiotic would not be as effective in killing the bacteria in the bone as it would be if the graft were not there to interfere. The site would be monitored for several weeks to a few months and if the infection appeared to be gone, then a second surgery would be done to add the graft material.

2) When a bone graft is done, excess material is placed in the socket to allow for some normal leakage as the site heals closed. However, the leakage should be minimal at best. If infection is the reason the graft was coming out, that indicates that the site was not healthy enough to receive it.

Your questions.... my answers in bold type.

<<<1. If the area is still infected (even though no obvious outward signs) will taking MORE antibiotics fix this or is it unlikely? I already took 2 back to back courses post-extraction which should have done the job>>>

IT IS UNLIKELY THAT ANTIBIOTICS WILL CURE THIS SITE IF THE INFECTION IS FROM THE ORIGINAL PROBLEM THAT WAS NOT TAKEN CARE OF PRIOR TO THE PLACEMENT OF THE GRAFT. TAKING SEVERAL COURSES OF ANTIBIOTICS POST OP WOULD BE EFFECTIVE IF THE GRAFT HAD NOT BEEN PLACED. THIS IS ALL CONTINGENT UPON THE NOTION THAT THE SURGICAL SITE WAS UNHEALTHY AND THE GRAFT INTERFERED WITH THE HEALING.

2. If the bine density isn't sufficeinet in 10 months time what are my options then?

THE OPTIONS REALLY DEPEND ON WHAT THE RADIO GRAPHS SHOW. IF THE BONE APPEARS LESS THAN IDEAL MEANING IT HAS NOT FILLED IN SOLID OR ADEQUATELY FROM THE GRAFT.... THEN PLACING AN IMPLANT INTO THAT BONE IS VERY RISKY BECAUSE YOU COULD BE LEFT WITH RECESSION AROUND THE IMPLANT LEADING TO POCKETING AND THE DEVELOPMENT OF INFECTION AND/OR IMPLANT FAILURE. PLACING GRAFT MATERIAL AROUND THE IMPLANT DURING THE IMPLANT SURGERY WOULD ONLY BE BENEFICIAL IF THE BONE WERE HEALTHY ENOUGH TO ACCEPT IT.

IN A HEALTHY SCENARIO AT 1O MONTHS POST OP, THE BONE WOULD LOOK SOLID AND 90%+ HEALED. PLACING THE IMPLANT WOULD BE SIMILAR TO PLACING IT IN HEALTHY VIRGIN BONE. SOMETIMES A "LITTLE" GRAFT MATERIAL IS PLACED ALONG WITH THE IMPLANT WHICH IS OKAY SO LONG AS THE BONE IS HEALTHY.

I'm sorry the options are what they are....... I think the issue here is whether or not the bone is healthy.

Please check back with us....
Bryanna

Hi Bryanna,
Checking back with an update and still very troubled by this tooth (or lack thereof to be precise). It has now been 11 months since I had it pulled and bone grafted. As I reported earlier, ever since the 4 month followup I have been plagued by sensitivity in the area of the missing tooth, to me it feels like a cavity in a tooth that isn't there. I just had my 10-month followup and x-ray and mentioned this to my perio again. The problem is the pain/sensitivity ebbs and flows, sometimes it is fine for weeks or months at a time and then it comes back. It is not pain in the sense that it is a big problem for me but rather I am concerned it is indicative of an ongoing infection and hence a sign of a bigger problem to come. At my 10-month followup I told the perio I felt it was about 99% as it hadn't bothered me in a while and sure enough 4 days later it came back unmistakeably. The perio is adamant that what I am experiencing is not due to an infection because there are no outward signs of one (no swelling/pus, gums look normal, etc). But I feel it took 10 years for my root canalled tooth to finally show symptoms of an infection so to me this is the only thing that it could be.

He (along with my regular dentist) agrees that the bone density is now sufficient to do the implant yet he won't proceed while I am experiencing these issues and is not offering me answers or solutions. I could wait another year with this big hole in my mouth and nothing could change. My regular dentist who also does implants agrees that nothing is likely to change by sitting and waiting and said he thinks the implant should be done. I am torn because I want something to happen either way and don't see how waiting could change anything but I also worry about trying to do an implant if the site is infected and having it fail.
I had a CT scan done of the area which shows a small dark area in the graft zone. My regular dentist thinks this could be the infection I am feeling but that most of that region would likely be removed during placement of the implant and that along with a course of antibiotics would clear everything up.
The perio refuses to believe this could be infection and thinks its just an area of less dense bone in that region. He says the rest of the bone would not have grown in as well if there was an infection in that area.

I feel like I am in limbo with no clear answers in sight, hoping you have a 3rd opinion to offer?

Hi N2L3,

I do have a 3rd opinion for you..... think twice before putting an implant in bone that shows a radiographic "void or pathology" in the bone. That void is most likely bacteria and/or the result of the bone graft material that was lost early on. I REMEMBER you stating "I know I lost a good chunk of graft material post-op with the infection causing it to ooze out, but because of the sensitivity I sometimes feel in the area I am convinced the infection is still present." Now "oddly" enough.... almost a year later you still have odd sensations in that area and there is a "void" in the bone.

To say that this "undiagnosed" area of missing bone would be removed during the placement of the implant does not mean that the surrounding bone is healthy. Also, you should know that as time goes on your natural bone as well as the bone graft will recede in that area. So you do not have unlimited amount of time to have the implant placed. However, placing the implant in questionable bone is risky.

Your situation is commonly seen in cases where the extracted tooth had been chronically ill for many years. There is no way to know for certain if the bone will ever become healthy again.

The choice to wait and see or do the implant is yours. Perhaps an oral surgeon unaffiliated with either of those other dentists could give you some further insight. By any chance could you post the recent x-ray of that area?

Bryanna

HI Bryanna,
As always your quick responses and opinion are appreciated. My gut agrees with you, I don't like the idea of doing the implant giving the way the area feels but also think sitting around and waiting for something to change won't help matters. I am wanting to go see someone for a 3rd opinion.
For sure the site was infected when the graft went in, the perio admitted they can only hope to get out 95-99% of the bacteria when they debribe and I didn't know at the time that it is best to wait to put the graft in. I am also aware that the bone will start to resorb after a while so what are my options?
Is it best to get the graft removed and the area debrided again using the CT scan as a guide to remove the dark areas? I can't see another option at this point. Do I choose another perio or an oral surgeon or does it matter? Should I be looking for a biological dentist, not knowing if they specialize in implants or not. I trust my perios surgical skills, he is highly ranked and respected but can't comprehend how he refuses to acknowledge the possibility of infection persisiting in the area. Here are my x-rays, 4month, 7 month and 10 month. I sadly don't have the CT scan slices but to me these really show the dark area more clearly than the x-rays.

Attached Thumbnails

     

Forgot to add that the perio suggested doing an exploratory surgery as an option, to peel back the gums and inspect the bone, I am arguing that the bacterial infection has to have an escape route which is why it hasn't led to inflamation and any obvious signs. He claims he would see this if he looked at the surface bone but I am not convinced that just looking at the surface will show any voids in deper in the bone. It just seems like more surgery that isn't leading anywhere. Your thoughts on this?