I had an upper implant and an extraction of the tooth next to the implant space that had a peridontal pocket infection so two teeth involved here). It's 10 days on and I am still getting a yellowy discharge from (I think) the extraction socket and not the new implant next to it. This tastes sour and is constant and profuse. I'm on antibiotics and am rinsing and cleansing the area carefully. I have no pain whatsoever apart from a little gum tenderness. I have faith in my dentist who thinks it will settle but to have this constant drip is a little unnerving.
Does anyone know what this constant seepage could be? I'm assuming it's an infection but it doesn't really have all the usual hallmarks.
Any help would be appreciated especially if from a dentist...

Hi janieburmy,

I am not a dentist but I am in the clinical aspect of dentistry for over 30 years. I can offer you some information here if you could share a bit more about the history of those teeth.

Had one or both of those teeth been root canaled? If so, how long ago? Did either of them have a root canal re treatment and/or apicoectomies performed at any time? Were they both periodontally involved? Had you ever developed fistulas, red pus filled bumps above the teeth? Do you have generalize periodonal disease throughout your mouth?

Thanks,
Bryanna





QUOTE=janieburmy;1134843]I had an upper implant and an extraction of the tooth next to the implant space that had a peridontal pocket infection so two teeth involved here). It's 10 days on and I am still getting a yellowy discharge from (I think) the extraction socket and not the new implant next to it. This tastes sour and is constant and profuse. I'm on antibiotics and am rinsing and cleansing the area carefully. I have no pain whatsoever apart from a little gum tenderness. I have faith in my dentist who thinks it will settle but to have this constant drip is a little unnerving.
Does anyone know what this constant seepage could be? I'm assuming it's an infection but it doesn't really have all the usual hallmarks.
Any help would be appreciated especially if from a dentist...[/QUOTE]

Thanks Bryanna ..I've been reading your posts to others and you seem exceptionally helpful and well informed and thanks for responding so quickly.

The upper tooth where the implant went in was extracted 10 years ago. Up until then I'd been living with the tooth next to it(that was extracted at the same time as the implant was placed in the old site) with a root filled crown bridge Pontic. This tooth developed ecr resorption discovered in December and an attempt at treating with with mta was done in January. A small piece of bone was removed at that time. The tooth never settled properly and had a peridontal pocket which when pressed emitted pus. We decided to get this removed after 3 months of it not settling. I have not got any other peridontal issues nor have I ever had and my health is good.
Implant was Uneventful apart from the fact that when he did the panoramic X-ray afterwards the impant seems to be in the thick soft tissue in my sinus. Totally not where he was expecting it. He's very experienced and has been doing implants for over 20 years and is highly reputable. His colleage thinks the pano may be a warping trick and it may not be in my sinus after all.
As I said, no pain and everything healing well other than this yellow sour tasting discharge.
Any help would be appreciated. Thank you.

Extra info just remembered...
Sorry, the extraction of the tooth where the implant went was about 15 years ago. That tooth broke after a root filling and a peridontal abscess necessitated it's removal. I had no problems after it's removal or with its healing. In UK terms it is my upper 5
The next tooth along, that I had extracted the other day...upper 6, the one with all the resorption issues was root filled in 2006 and bridge placed then too. I hadn't noticed any problems with it until the dentist picked up on the resorption in December.

...just an update on today - I'm on day 5 of the antibiotics (amox) and this morning I noticed that the discharge was no longer yellowy, but clear. It is still profuse and still tastes the same. Definitely a sour taste - a bit like lemon juice...I do not have any fluid or any sensation of anything when I drink or eat. The discharge only seems to be one way - out of my socket (or implant??) I am beginning to think I might have a sinus perforation but unsure of where is is definitely perforated. If the perforation was the exttraction site would I be more likely to have a two way communication or if it's coming from the implant site, would it only be one way (i.e. down the spiral of the implant) and not upwards? I could be jumping the gun here completely as my dentist says that my implant would completely seal the perforation if it indeed did perforate the sinus (and he's still not sure that it did). And he assured me that he did not see any rupture of the bony shell when he took out my number 6. He even went as far as saying that he deliberately DIDN'T take out a piece of gutta percha from the extraction site because he didn't want to run the risk of damaging the sinus so he left it in there (when I saw the x-ray after the extraction I asked him was it was left in the extraction socket).

SO much information - I do hope you can make some sense of it all.

Hi janie,

I was waiting for you to give an update and share a bit more info after your last 2 posts as there are a lot of issues going on with your dental situation. You have mentioned that you trust your dentist and that you feel he is good at what he does. That is fine but my feeling is that you may not have been fully informed by your dentists of the reasons for all of these complications. Which is not unusual as you can see just by the people who have come here looking for information.

Not having any x-rays to review, I can offer you my opinion based on your detailed description and my professional experience working chair side with oral surgeons, etc.

The first and most important issue that laid the foundation for the complications is the fact that the teeth had been had root canaled. Without question and irrelevant of physical symptoms, these non vital teeth were infected for many years. That is clearly evident based on the fact that you developed periodontal disease from the proliferation of the bacteria that originated inside of these teeth. I want to note here that this occurrence is typical of root canaled teeth and the progression of this infection can be seen on routine dental radio-graphs long before it becomes a severe problem. That is why you had different dental treatment to attempt to eradicate the infection and reduce the pocketing and bone loss. These treatments were unsuccessful because the source of the infection were the teeth and irrelevant of what was done, the bacteria residing inside of the teeth was going to continue to grow, multiply and spread beyond the teeth. Also, antibiotics may temporarily reduce the acute inflammation but the meds are not able to kill off the various species of bacteria that continue to multiply inside and outside of teeth.

Based on the information that you have shared here, the health of the bone and the floor of the sinus in that area of your mouth was/is compromised from the long standing infection. Placing a dental implant there was not only risky but likely to create a sinus perforation or at least insult an existing sinus perforation. Another reason to confirm that the site is still unhealthy is your statement about "the dentist not removing the gutta percha when he extracted the tooth for fear of damaging the sinus". This indicates that the bone was so compromised that instrumentation of it to remove the gutta percha could have resulted in additional bone loss and either perforated or further perforated the sinus making the placement of the dental implant impossible. So knowing that the gutta percha would be a chronic bacterial irritant, he chose to leave it so he could place the implant. It was a judgement call on his part. From a health perspective, leaving that gutta percha is the same as leaving a piece of infected tooth in there. I have seen this exact thing done many many times, so it is not unusual for a dentist to make that decision. However, down the road if you were to see a different dentist and he were to discover this retained gutta percha on an x-ray, he may very well have a different opinion on that being in there.

The other issue I feel you need more information about is regarding the dentists statement about the implant sealing the sinus perforation. There are a few things a bit skewed with that theory. The implant is a piece of metal that does not have the biological integrity to build cells to close the sinus membrane tissue together. A healthy membrane at the floor of the maxillary sinus is very thin like a piece of wet kleenex tissue but it is quite resilient. An unhealthy membrane, one that has been perforated by a foreign object and/or perforated from the bacteria of a chronic infection is not resilient and in fact very fragile. The dental implant is an irritant to the broken membrane and the perforation may or may not close around that implant because bacteria can migrate into that opening preventing it from closing. Sometimes a collagen membrane is placed inside the socket over the opening before the implant is put in if the dentists suspects there to be a sinus opening. The collagen encourages healing cells to close the sinus membrane. But it does not sound like your dentist anticipated an opening of the sinus and is still unsure if there is one. However, your drainage symptoms indicate a sinus perforation. The antibiotics may temporarily subside the symptoms... make the discharge clear... but that does not necessarily indicate that the problem is being cured.

I know all of this information is hard to read and can be a bit scary if not disappointing to hear "after the fact". But because you have sought information outside of what your dentist is giving you, I feel obligated to be straight forward with you and offer you as much information as I can in laymens terms. There are several other biological issues associated with your dental situation but the most important is the health risk from this being a chronic source of infection, which it has been for several years, is that the bacteria can migrate beyond the sinus and go into the brain. I know that is not what you want to hear but it is something to be informed about as you go along this journey with the dental implant.

You may have mentioned this but .... did you have a dental Ct scan of that area of your mouth prior or post op the placement of that dental implant?

Bryanna

Thanks you so much for your very detailed response. I really do appreciate your comments and they help me to understand the dynamics possibly going on here.
I feel I have misled you a little on one of the points though...my 6 extraction that took place a fortnight ago does not have an implant in it. It is still healing.
The 5, where I have the new implant, only lasted about a year (15 years ago) with the root filling in it before I cracked the tooth and it had to come out (admittedly after developing the periodontal abscess I spoke about). I can pm you my X-rays of the site prior to implant if that's helpful. I do not have any post treatment.
I had x-rays, but no CT scan. They are not routinely available here and I did ask about being referred for one prior to the implant but was advised that in all his years in hospitals working with ct scans for implants, he felt they didn't give any real advantage over several well placed apical x-rays and gave far more radiation. That kind of thing that subjects patients to radiation has to be justified here in the UK.
Emailed my dentist today to give him an update and he is confident that he did not penetrate the sinus membrane even if he did actually penetrate the bony sinus shell. He also said that he could see the shell of the sinus and it was intact on the tooth he extracted.
My antibiotics course is finished now. The discharge is far less this afternoon than it was. Not sure where to go from here.

Hi janie,

Yes, please send me the pre op xrays. Did I understand you correctly in that you have not had any post op x-rays after the implant was placed? Without taking a post op x-ray, there is no way to know the location of that implant in relation to the sinus. I have assisted on countless surgical procedure to place dental implants and I have always taken at least 2 x-rays at the time of the placement. One is taken at the onset of placing the implant to be sure of the location and angle of the placement and the second x-ray is taken as a final x-ray to determine the exact location/depth of the implant just before we dismiss the patient. I truly do not know of any oral surgeon who does not take post op placement x-rays.

Regarding the dental CT scan, yes it is more radiation than regular dental x-rays. However, in most cases involving the maxillary a DENTAL CT scan is done prior to the surgery to rule out radio graphic pathology (infection or an anomaly), to determine the location and density of the sinus and to calculate the height, density and depth of the existing bone. Without that scan, the dentist goes into the bone based on the limited findings on a 2 dimensional x-ray.

So tooth #5 was root canaled and after one year it was extracted and that occurred 15 years ago, correct? Supposedly this is where the dentist put the recent dental implant, correct? Tooth #6 had also been root canaled and was recently extracted, correct? What is the plan to replace that tooth?

If that is the case then the jaw bone of where tooth #5 had been extracted from many years ago did not remain open, did it? Or did the adjacent teeth #6 and #4 move in toward that open space?

Bryanna

Hi there.
Yes two X-rays done after implant; I just don't possess copies. One showed implant 2 mm into sinus. A panoramic was also done.
The 5 space did not get smaller as it was filled with a bridge. The plan for the 6 is another implant eventually but dentist feels it will be at least 6 to 9 months before it fills in enough. No bone graft placed at time of extraction and no discussion as to whether it might need one. Thanks Bryanna..have I covered everything you asked?

Janie,

Yes and we can talk via email.

Bryanna