[hungtru]

Hi there,

I have had an implant where my #7 tooth was about 6-7 years ago. Things went well and i am happy with it. The tooth is currently solid and there's no mobility.

Recently, during my last check up, my dentist noticed a fistula above the implant and it was oozing puss. She sent me to the periodontist that put in the implant and he indicated that it was a chronic infection, that there was no significant bone loss, and the implant was not loose. But he said to just to continue to monitor it.

I visited another periodontist for a consultation on a deep pocket on one of my molars and during her evaluation - she too noticed the fistula. She indicated that there's a possibility that the implant may fail overtime because it is an indication that there's chronic infection that would eventually break down surrounding bone. But she indicated that this does occur often and not everyone's implant fails. She suggested that there's nothing to do and that there's nothing on my end that will help.

My concern is the infection is never resolved. I'm not sure what to do. I don't want to have bone loss such that my implant would fail...but i'm assuming to resolve this would require the removal of the implant? I am worried that the infection will continue to eat away at the surrounding bone and the implant will eventually fall out - leaving the only option to get a bridge.

What are your thoughts? Is there anything that can be done?

Thanks,
h

[Bryanna]

Hi hungtru,

I am in the dental field and can offer you some information here.

You are right to be very concerned about this infection. Not only can it continue to spread to the adjacent teeth and continue to cause further bone loss but it could also spread to the sinuses and even result in a systemic infection as well.

I am going to assume that tooth #7 had been infected or root canaled prior to the extraction.... yes?

I am going to disagree with your dentist and say that a pus draining fistula above a dental implant is not common and it indicates a progressive infection. With that said, taking a nonchalant approach is really not in your best interest.

Unfortunately the only way to attempt to remedy this infection would be to remove the implant and have the bone thoroughly debrided. In all probability there will not be enough healthy bone to put in a new implant. So your replacement options would be a permanent bridge or a removable partial denture. Keep in mind that the more bone loss that occurs the more difficult it will be to obtain an esthetically pleasing replacement because you can end up with severe recession making the margin of the gum line much higher than the adjacent teeth.

I would suggest that you seek a consultation with an oral surgeon. Make sure you have all of your pre op and post op xrays of the implant sent to him... or bring them with you. It is best for him to know the dental history and to see what the area looked like prior to the placement of the implant.

Please keep us posted on how you're doing!

[dbpei]

hungtru, I am so sorry for what you are going through. I want to share my experience so maybe we can help each other. Last May, I developed a fistula in the roof of my mouth near my 2008 dental implant. It was attributed to an infected molar right next to the implant (#14) and I had the molar (#15) extracted in June.

I had been having a lot of odd symptoms at the time, which we hoped would resolve after the infected tooth was extracted, but they have not. These include mild dental/jaw pain, tingling, heat, numbness, bug crawling sensations, feeling of electricity or buzzing going through my head, head and ear pressure changes and horrible tinnitus. These symptoms are very frightening to me and I am afraid something is happening that could travel to my brain.

Before I had the extraction last June, we discovered that I have a cyst directly above my implant and above the tooth that was extracted. I have seen 2 ENT's and 2 oral surgeons, all of whom think this cyst is benign, implant and surrounding bone look great. They attribute my symptoms to neurological damage from lyme disease, which I developed some time ago. I recently went back to the oral surgeon who extracted last year's molar and he ordered a new cat scan, which we will discuss tomorrow. I also am awaiting results of MELISA blood test to see if I might have developed some type of allergy or sensitivity to the metals in my implant. I am very grateful that this oral surgeon is at least investigating further. I know that oral surgeons do not feel comfortable removing intact dental implants and it will likely be a challenge to find someone willing to do this, if that is what I need to do.

I am attaching a photo of the cat scan showing the cyst above my implant. Sorry, it is not the right orientaion! I don't know how to correct. I hope Bryanna will chime in with her wealth of knowledge and insight. Good luck to you and please write and keep us all posted!