[johnbull]

I had bone augmentation surgery done in the upper back jaw some 7 weeks ago. It was to provide bone sufficient to take one or two implants in around 8 months time.
Graft material, I'm not sure what, in the form of white granules was packed into the cavity drilled into the existing bone, and a membrane placed over the top. However I have been in pain ever since! According to my dentist it seems some of the small white granules have found their way past the membrane, and my dentist says it's these that are causing the pain. He has removed some of these loose particles, on four different occasions, but I still have a dull almost constant pain in the area.
I'm very frustrated with the situation, having been suffering, what is like a tooth ache pain, for this period of time.
Any suggestions as to what can now be done? Thank you

[Bryanna]

Hi johnbull,

A couple of questions...

Was the surgery done by a general dentist, oral surgeon or periodontist?

How long ago were the teeth removed? Had they been previously root canaled (how long ago?) and/or infected (for what length of time)?

Was there any mention of a sinus communication or perforation either when the teeth were present... extracted... or when the grafts were done? Did or do you have any sinus discomfort or sinus infection?

It is typical for some bone graft granules to come out during the healing. So long as nothing major comes out, it is normal. Sometimes the pieces can get caught in the tissue and cause some irritation or soreness. But generally this is not painful per say, just sore.

Bryanna

Originally Posted by johnbull

I had bone augmentation surgery done in the upper back jaw some 7 weeks ago. It was to provide bone sufficient to take one or two implants in around 8 months time.
Graft material, I'm not sure what, in the form of white granules was packed into the cavity drilled into the existing bone, and a membrane placed over the top. However I have been in pain ever since! According to my dentist it seems some of the small white granules have found their way past the membrane, and my dentist says it's these that are causing the pain. He has removed some of these loose particles, on four different occasions, but I still have a dull almost constant pain in the area.
I'm very frustrated with the situation, having been suffering, what is like a tooth ache pain, for this period of time.
Any suggestions as to what can now be done? Thank you

[johnbull]

Originally Posted by Bryanna

Hi johnbull,

A couple of questions...

Was the surgery done by a general dentist, oral surgeon or periodontist?

How long ago were the teeth removed? Had they been previously root canaled (how long ago?) and/or infected (for what length of time)?

Was there any mention of a sinus communication or perforation either when the teeth were present... extracted... or when the grafts were done? Did or do you have any sinus discomfort or sinus infection?

It is typical for some bone graft granules to come out during the healing. So long as nothing major comes out, it is normal. Sometimes the pieces can get caught in the tissue and cause some irritation or soreness. But generally this is not painful per say, just sore.

Bryanna

Bryanna,
Thank you!
I had the surgery done in Spain by a highly qualified German dentist, who holds an M.Sc master's degree in Implantology and Oral surgery, and leactures at the local university.
The teeth had been removed, many (over 10) years previously, and to my knowledge had not been root canaled or infected.
There was no mentions of sinus communication or perforation, and i have had no sinus discomfort or sinus infection.
I have had soreness and discomfort due I think to the loose granules, but currently also have an almost constant dull toothache like pain in the surgical upper jaw area. Also I have the dull pain in my forehead and in the back of my head on that side. Additionally right next to the area of surgery is a new (completed just before surgery) implant tooth with crown, that feels 'numb' all the time, I'm not sure if this is usual.
Could it be that the area is infected and causing the pain. I did have a course of penicillin after surgery, but maybe I need some more penicillin or an alternative?

[Bryanna]

Hi Johnbull,

Thank you for answering those questions and sharing more of your dental history.

A few more if you don't mind...

Did the dentist take a 3D scan prior to doing any of this dentistry or is he working off of 2D dental xrays only?

Regarding the recent dental implant and crown in the adjacent area to the surgical site....
When was that tooth extracted? Had that tooth been root canaled or infected? Was there any sinus involvement with that tooth or the extraction of it? How long after the extraction was the dental implant put in? How long after the implant placement was the crown put on? Has it felt numb since the extraction or since the implant placement or since the crown was put on?

Regarding the the two teeth that were extracted 10+ years ago...
What was the reason they were removed?

When a tooth is extracted there is going to be some degree of bone loss as the tooth socket does not fill up with bone to it's original height. If nothing is put into that bone to hold the height of the bone, the level of bone will continue to decline as time goes on. If there was chronic long term infection in that area of bone from an infected tooth, then it creates an even more fragile situation.

Placing a bone graft in an area of healthy jaw bone where teeth have been removed 10 years prior is a risky undertaking because there is not much if any existing bone for the graft to integrate into. There are measures that can be taken to encourage the graft to be stable but the existing bone has to be healthy, the person has to be healthy and the surgery has to be impeccable for an optimal outcome.

Placing a bone graft in an area of unhealthy jaw bone under the same (above) circumstances has very little chance of success.

The history of the teeth that were extracted is pertinent because chronic, long standing tooth infections, either from root canaled teeth ... badly decayed teeth ... or injured or fractured teeth, are capable of causing unfavorable and sometimes resistant or even permanent changes to occur in the jaw bone. These changes can result in significant bone loss ... a bone disease called Osteonecrosis in which the body is unable to rebuild new bone due to a history of reduced blood flow in that area of the bone .... or a chronic bone infection referred to as Osteomyelitis in which the long standing infection from the tooth traveled to the bone and continues to reside there.

Anytime there is extended post operative complications.... pain, numbness, swelling, etc..... the root cause of those problems need to be sought to avoid further complications. Sometimes the pre operative history gives clues to what the problems may be.

Have you informed the dentist about the numb feeling with the dental implant? What is his response?

In the lower quadrant on this same side ... what is the health of the teeth that are biting against this crowned dental implant? Are those lower teeth restored with fillings or crowns?

Bryanna

Originally Posted by johnbull

Bryanna,
Thank you!
I had the surgery done in Spain by a highly qualified German dentist, who holds an M.Sc master's degree in Implantology and Oral surgery, and leactures at the local university.
The teeth had been removed, many (over 10) years previously, and to my knowledge had not been root canaled or infected.
There was no mentions of sinus communication or perforation, and i have had no sinus discomfort or sinus infection.
I have had soreness and discomfort due I think to the loose granules, but currently also have an almost constant dull toothache like pain in the surgical upper jaw area. Also I have the dull pain in my forehead and in the back of my head on that side. Additionally right next to the area of surgery is a new (completed just before surgery) implant tooth with crown, that feels 'numb' all the time, I'm not sure if this is usual.
Could it be that the area is infected and causing the pain. I did have a course of penicillin after surgery, but maybe I need some more penicillin or an alternative?

[johnbull]

Bryanna,

Thank you for your continued help.

The dentist took a 3D scan prior to surgery.

Sorry, but I find it difficult to answer some of your the question precisely, because the extractions were done, as I said, a very long time ago!

The extracted tooth that now has an implant and crown, to my knowledge was not canaled or infected. I can't remember when it was extracted but it was many years ago. The implant was put in March this year, the crown was put on 7 1/2 months later. It's crown (along with the two other implant crowns I had done at the same time) I now remember, was actually put on about a week after the bone surgery, but it's numbness was not felt until a couple of weeks later.

The two teeth that were extracted 10+ years ago were I think removed because of decay after probably being crowned.

I think the dentist would say that the bone in question, although not deep enough to support any implants, seemed healthy. I myself am healthy besides having type 2 diabetes..

I see the dentist next week and will tell him then of the current symptoms, including the numb feeling which I don't think he is aware of.

The lower teeth that are biting against this crowned dental implant have fillings..

If I assume that the bone graft is failing or has failed, what can be done? Obviously the clock can't be turned back, but if it's this that is giving me the pain, how can the pain be alleviated?. I care not that if its failed and I can't therefore have the proposed implants, I obviously just want to be pain free.

Could it just be an infection do you think?

[Bryanna]

Hi Johnbull,

Glad to hear that he took a 3D scan as that gives a multi dimensional view of the bone, sinus, etc than a routine dental xray.

The outcome of your implant surgery is dependent upon several factors but perhaps the most significant are:

1) The health of the mouth overall, teeth, gums, etc and also the reason for the teeth needing extraction is important because any long standing infection will leave a less then ideal, foot print (so to speak) in the bone. Tooth infections occur from decay, root canal therapy, abscess, periodontal disease, and certain trauma that cause the nerves to die in a tooth. When any of those circumstances become long term, meaning are able to brew for months or years, the integrity and health of the jaw bone will be affected.

2) When an infected tooth is extracted, if the dentist does not perform a thorough surgical debridement of the socket and remove all of the tooth, as well as the diseased ligament and diseased bone, the area will continue to carry some degree of the infection. Typically resulting in post operative complications when a bone graft and/or a dental implant is placed. The same goes for someone with active periodontal disease. If the disease has not been arrested, any invasive oral surgery may result in post operative complications.

3) The health of the patient is critical as well as their nutritional health and other lifestyle habits. A smoker, drug user legal or otherwise, alcohol consumption and poor eating habits all affect the oral health. There is also an increased frequency of gum disease among those with Diabetes as research shows that gum disease has the potential to affect blood glucose control. It also works the other way around in that someone with gum disease is more prone to develop Diabetes and for the same reason.

3) The oral surgery itself needs to be performed in a very sterilized manner with minimum contamination of any kind.

The bottom line is that there are many reasons for there to be post operative complications after any dental procedure including oral surgery. Most often there are combined reasons and until all of these details are discussed and a conclusion is derived, the situation will remain similar or worsen over time. It is never a good idea to ignore an oddity, like prolonged numbness, after any dental procedure.

Regarding the current bone grafted area.... whether or not it is infected, I don't know as that depends on how healthy the bone was when the implant was placed. There also has to be enough of your own healthy bone present to place bone graft material into. The holes surgically drilled into the existing bone need to be deep enough to hold the graft as the graft itself is meant to stimulate your own bone cells to grow new bone and take over the graft material. It is not something that can just be placed in shallow areas or laid on top of existing bone as it will have nothing to integrate with. Extraction sites that are 10 years old generally have receded quite a bit. Some people have thicker, denser bone than others and in those cases the loss of bone may be less than in someone who has thinner, less dense bone. Perhaps your bone is in the positive category rather than the negative..?? Did your dentist explain any of this to you at all?

The health of the opposing teeth on the lower arch can affect the fit, durability and comfort of any restorations on the upper teeth. The occlusion (bite) needs to be fitting properly to avoid excessive wear on either the top or the bottom. Sometimes this can be difficult to achieve if the opposing teeth have old worn down restorations or are compromised due to periodontal disease.

If the upper site is infected then in most cases the graft would need to be removed and the site would need to be surgically debrided. It is not an easy diagnosis to make unless there is a blatant abscess. So it is important to discuss these issues in detail with your dentist. Make sure that he is very aware of your symptoms and also aware of any other medical, nutritional or lifestyle issues that you feel can be relevant in your case.

I'm sorry I cannot help pinpoint the problem with you but the history and other factors are big issues to take into consideration. I hope I have given you enough important information to be able to discuss this situation with your dentist.

Please let us know how things are going.
Bryanna

Originally Posted by johnbull

Bryanna,

Thank you for your continued help.

The dentist took a 3D scan prior to surgery.

Sorry, but I find it difficult to answer some of your the question precisely, because the extractions were done, as I said, a very long time ago!

The extracted tooth that now has an implant and crown, to my knowledge was not canaled or infected. I can't remember when it was extracted but it was many years ago. The implant was put in March this year, the crown was put on 7 1/2 months later. It's crown (along with the two other implant crowns I had done at the same time) I now remember, was actually put on about a week after the bone surgery, but it's numbness was not felt until a couple of weeks later.

The two teeth that were extracted 10+ years ago were I think removed because of decay after probably being crowned.

I think the dentist would say that the bone in question, although not deep enough to support any implants, seemed healthy. I myself am healthy besides having type 2 diabetes..

I see the dentist next week and will tell him then of the current symptoms, including the numb feeling which I don't think he is aware of.

The lower teeth that are biting against this crowned dental implant have fillings..

If I assume that the bone graft is failing or has failed, what can be done? Obviously the clock can't be turned back, but if it's this that is giving me the pain, how can the pain be alleviated?. I care not that if its failed and I can't therefore have the proposed implants, I obviously just want to be pain free.

Could it just be an infection do you think?

[johnbull]

Originally Posted by Bryanna

Hi Johnbull,

Glad to hear that he took a 3D scan as that gives a multi dimensional view of the bone, sinus, etc than a routine dental xray.

The outcome of your implant surgery is dependent upon several factors but perhaps the most significant are:

1) The health of the mouth overall, teeth, gums, etc and also the reason for the teeth needing extraction is important because any long standing infection will leave a less then ideal, foot print (so to speak) in the bone. Tooth infections occur from decay, root canal therapy, abscess, periodontal disease, and certain trauma that cause the nerves to die in a tooth. When any of those circumstances become long term, meaning are able to brew for months or years, the integrity and health of the jaw bone will be affected.

2) When an infected tooth is extracted, if the dentist does not perform a thorough surgical debridement of the socket and remove all of the tooth, as well as the diseased ligament and diseased bone, the area will continue to carry some degree of the infection. Typically resulting in post operative complications when a bone graft and/or a dental implant is placed. The same goes for someone with active periodontal disease. If the disease has not been arrested, any invasive oral surgery may result in post operative complications.

3) The health of the patient is critical as well as their nutritional health and other lifestyle habits. A smoker, drug user legal or otherwise, alcohol consumption and poor eating habits all affect the oral health. There is also an increased frequency of gum disease among those with Diabetes as research shows that gum disease has the potential to affect blood glucose control. It also works the other way around in that someone with gum disease is more prone to develop Diabetes and for the same reason.

3) The oral surgery itself needs to be performed in a very sterilized manner with minimum contamination of any kind.

The bottom line is that there are many reasons for there to be post operative complications after any dental procedure including oral surgery. Most often there are combined reasons and until all of these details are discussed and a conclusion is derived, the situation will remain similar or worsen over time. It is never a good idea to ignore an oddity, like prolonged numbness, after any dental procedure.

Regarding the current bone grafted area.... whether or not it is infected, I don't know as that depends on how healthy the bone was when the implant was placed. There also has to be enough of your own healthy bone present to place bone graft material into. The holes surgically drilled into the existing bone need to be deep enough to hold the graft as the graft itself is meant to stimulate your own bone cells to grow new bone and take over the graft material. It is not something that can just be placed in shallow areas or laid on top of existing bone as it will have nothing to integrate with. Extraction sites that are 10 years old generally have receded quite a bit. Some people have thicker, denser bone than others and in those cases the loss of bone may be less than in someone who has thinner, less dense bone. Perhaps your bone is in the positive category rather than the negative..?? Did your dentist explain any of this to you at all?

The health of the opposing teeth on the lower arch can affect the fit, durability and comfort of any restorations on the upper teeth. The occlusion (bite) needs to be fitting properly to avoid excessive wear on either the top or the bottom. Sometimes this can be difficult to achieve if the opposing teeth have old worn down restorations or are compromised due to periodontal disease.

If the upper site is infected then in most cases the graft would need to be removed and the site would need to be surgically debrided. It is not an easy diagnosis to make unless there is a blatant abscess. So it is important to discuss these issues in detail with your dentist. Make sure that he is very aware of your symptoms and also aware of any other medical, nutritional or lifestyle issues that you feel can be relevant in your case.

I'm sorry I cannot help pinpoint the problem with you but the history and other factors are big issues to take into consideration. I hope I have given you enough important information to be able to discuss this situation with your dentist.

Please let us know how things are going.
Bryanna

Bryanna,

Update on my problem:

I still have an almost continual dull pain in the area of the graft.

My dentist confirmed he carried out an external sinus lift graft. On a 2D x ray he noticed a small dark area just next to the bone graft. He has now opened up this area and found no sign of infection. He still thinks that I probably have an infection and prescribed a course of anti-biotics (known here in Spain as Rhodogil), I have also had a course of penicillin (known here in Spain as Amoxicillin), taken around 5 weeks ago. Neither has had effect on my problem. He is now going to refer me to a ENT specialist for advice on what other anti-biotic to use.

He thinks the numb feeling I am experiencing in the implant/crown adjacent to the bone graft is due to the infection he thinks is there.

I think it’s getting to the time for him to remove the bone graft, which he is reluctant to do because he says its healing OK. But agrees that somewhere in that area he thinks its infected!

Q, If I have an infection of the actual graft would it show up on an x-ray?
Q. The bone graft was carried out 2 months ago now. Is it still possible to have it removed, is it now important to get it done ASAP, or can I afford to wait another 2 weeks say, to get a ENT specialist opinion? BTW The dentist says the membrane has started to dissolve.
Q. Is removing the graft now and removing any infection a complicated procedure?

[johnbull]

Originally Posted by Bryanna

Hi Johnbull,

Glad to hear that he took a 3D scan as that gives a multi dimensional view of the bone, sinus, etc than a routine dental xray.

The outcome of your implant surgery is dependent upon several factors but perhaps the most significant are:

1) The health of the mouth overall, teeth, gums, etc and also the reason for the teeth needing extraction is important because any long standing infection will leave a less then ideal, foot print (so to speak) in the bone. Tooth infections occur from decay, root canal therapy, abscess, periodontal disease, and certain trauma that cause the nerves to die in a tooth. When any of those circumstances become long term, meaning are able to brew for months or years, the integrity and health of the jaw bone will be affected.

2) When an infected tooth is extracted, if the dentist does not perform a thorough surgical debridement of the socket and remove all of the tooth, as well as the diseased ligament and diseased bone, the area will continue to carry some degree of the infection. Typically resulting in post operative complications when a bone graft and/or a dental implant is placed. The same goes for someone with active periodontal disease. If the disease has not been arrested, any invasive oral surgery may result in post operative complications.

3) The health of the patient is critical as well as their nutritional health and other lifestyle habits. A smoker, drug user legal or otherwise, alcohol consumption and poor eating habits all affect the oral health. There is also an increased frequency of gum disease among those with Diabetes as research shows that gum disease has the potential to affect blood glucose control. It also works the other way around in that someone with gum disease is more prone to develop Diabetes and for the same reason.

3) The oral surgery itself needs to be performed in a very sterilized manner with minimum contamination of any kind.

The bottom line is that there are many reasons for there to be post operative complications after any dental procedure including oral surgery. Most often there are combined reasons and until all of these details are discussed and a conclusion is derived, the situation will remain similar or worsen over time. It is never a good idea to ignore an oddity, like prolonged numbness, after any dental procedure.

Regarding the current bone grafted area.... whether or not it is infected, I don't know as that depends on how healthy the bone was when the implant was placed. There also has to be enough of your own healthy bone present to place bone graft material into. The holes surgically drilled into the existing bone need to be deep enough to hold the graft as the graft itself is meant to stimulate your own bone cells to grow new bone and take over the graft material. It is not something that can just be placed in shallow areas or laid on top of existing bone as it will have nothing to integrate with. Extraction sites that are 10 years old generally have receded quite a bit. Some people have thicker, denser bone than others and in those cases the loss of bone may be less than in someone who has thinner, less dense bone. Perhaps your bone is in the positive category rather than the negative..?? Did your dentist explain any of this to you at all?

The health of the opposing teeth on the lower arch can affect the fit, durability and comfort of any restorations on the upper teeth. The occlusion (bite) needs to be fitting properly to avoid excessive wear on either the top or the bottom. Sometimes this can be difficult to achieve if the opposing teeth have old worn down restorations or are compromised due to periodontal disease.

If the upper site is infected then in most cases the graft would need to be removed and the site would need to be surgically debrided. It is not an easy diagnosis to make unless there is a blatant abscess. So it is important to discuss these issues in detail with your dentist. Make sure that he is very aware of your symptoms and also aware of any other medical, nutritional or lifestyle issues that you feel can be relevant in your case.

I'm sorry I cannot help pinpoint the problem with you but the history and other factors are big issues to take into consideration. I hope I have given you enough important information to be able to discuss this situation with your dentist.

Please let us know how things are going.
Bryanna

Bryanna,

Update on my problem:

I still have an almost continual dull pain in the area of the graft, and I am getting desperate.

My dentist confirmed he carried out an external sinus lift graft. On a 2D x ray he noticed a small dark area just next to the bone graft. He has now opened up this area and found no sign of infection. He still thinks that I probably have an infection and prescribed a course of anti-biotics (known here in Spain as Rhodogil), I have also had a course of penicillin (known here in Spain as Amoxicillin), taken around 5 weeks ago. Neither has had effect on my problem. He is now going to refer me to a ENT specialist for advice on what other anti-biotic to use.

He thinks the numb feeling I am experiencing in the implant/crown adjacent to the bone graft is due to the infection he thinks is there.

I now want him to remove the graft, which he is reluctant to do because he says its healing OK. But agrees that somewhere in that area he thinks its infected!

The bone graft was carried out 2 months ago now. Is it still possible to have it removed easily? is it now important to get it done ASAP, or can I afford to wait another 2 weeks say, to get a ENT specialist opinion? BTW The dentist says the membrane has started to dissolve.

Is removing the graft now and removing any infection a complicated procedure?

Thank you.