Angels,

Removing the implant would only be a part of the remedy, but not the cure. First the proliferation of the infection and bone deterioration of your upper left maxillary arch and sinus, needs to be determined as best as possible before any oral surgery is done. Otherwise, the surgery will be incomplete. The proliferation of the systemic infection, meaning in your blood system, needs to be evaluated with specific blood tests prescribed by a knowledgeable practitioner (perhaps infection disease specialist) who knows what key markers to look for in the blood. A culture of the findings is also very helpful to determine the proper antibiotic(s) to use. This is not just a routine blood test.

A planned surgical approach to remove the implant and debride the areas of infection from the bone and sinus is then presented and executed in conjunction with the administration of the proper medication.

Jaw bone infection is determined by several things. The more pronounce the infection the easier it is to pick up. It can often be seen radio graphically on some 2 and usually 3 dimensional xrays, 3D CT Scans, some MRI's, bone scans, and when a surgeon goes in to extract a tooth or place a dental implant the infected bone has an odor that is hard to miss ... it can usually be seen and/or felt with surgical instruments as the infected bone is not solid or the same color as healthy bone.

The trigeminal nerve has many sensory branches which feed into other nerve bundles throughout the head, face and neck. Each tooth in the mouth is intimately connected to sensory nerves that stem off of the trigeminal nerve.
Residual infection in the jaw bone of extracted 14 and 15 and/or in the sinus of same area ... in addition to the dental implant in 14 site could easily be irritating and inflaming the sensory nerves of the TN that affect the ear, thus the ringing in your ear, etc.

Bryanna

I am going in for an MRI in a few hours. the whole area where the implant was placed is aching and hurting off and on and I am getting a very sour taste in that area. Even my jaw is hurting. The left side of my neck is swollen and my left ear is ringing loudly still. I feel horrible like I have an infection still. It has been a tough day as I almost lost my puppy who had a severe anaphylactic shock after she got stung by a bee this morning. Thank god I threw her in the car and took her to,the ER. Hopefully I will be able to sleep in the MRI tube. I really hope it shows something, I truly don't know how I will live with this much longer.

Angels,

You do have an infection and it needs to be properly diagnosed. You cannot go on much longer like this without further problems developing. I hope the MRI is diagnostic of that area. However, I would not solely rely on the opinion of your oral surgeon or the ENT because they have both be dismissal and non informative in the past.

I hope your puppy is okay... how scary!!

Please keep in touch here....
Bryanna

Hi Bryanna,

Yay! I am finally getting somewhere!! I just got a call from the ENT and they found inflammation and what they think is osteomyelitis above the implant from the MRI yesterday. I also have sinusitis on the left side. They are sending a copy of the MRI to the oral surgeon. And they are figuring out a plan. The only problem is now I am a little afraid to go to same oral surgeon. Not sure how to handle that.

Angels,

In one of my pm's to you I mentioned the possibility of you having osteomyelitis. This finding is not a surprise at all and it is not a "new" or "recent" occurrence. Irrelevant of whether it is seen or acknowledged by your dentist on previous scans, it was more than likely present not just this past 20 months, but prior to that because osteomyelitis is not an uncommon finding in the jaw bone of teeth that have been root canaled. Conventional dentists do not like to talk about osteomyelitis because it leads to too many questions about long term infection from root canaled teeth or questions about improper surgical debridement during the extraction of teeth. I am sharing this information with you in case your oral surgeon or other dentist seem disinterested or not overly concerned about this diagnosis. Biological dentists see osteomyelitis for exactly what it is ... a serious systemic bone infection.

Osteomyelitis is a bone infection which can happen in any bone of the body. It is a very invasive infection that travels through the bloodstream and therefore easily to the surrounding areas, and beyond, of the original site. This would explain why you have all the on going symptoms that you do with your upper left sinuses, mouth, left ear, left glands in your neck.

The inflammation and sinusitis are not separate from the osteomyelitis. One should not be treated without the other. Meaning antibiotics are not going to cure the inflammation or the sinusitis so long as the osteomyelitis is present.

Did you tell the ENT that you are hesitant to go back to this oral surgeon? If not, then you really should because he may be "glad" to hear that because he will not take it upon himself to refer you elsewhere if he thinks you are comfortable seeing that oral surgeon. Please, don't assume anything this time around and make sure that the ENT knows how you feel. The ENT needs to speak directly to whatever oral surgeon you are going to go to.

I cannot stress enough to go with your gut instinct on this. Don't dismiss the numerous times that oral surgeon dismissed your symptoms or how he scared you into doing the implant or how he didn't diagnose the osteomyelitis before now. If you trust the ENT to take care of you properly, then he needs to know all of these things asap so he can collaborate a treatment plan with a different oral surgeon.

Bryanna

Hi Bryanna,
This is a little more complicated than I thought. The ENT just called me and told me he spoke to the oral surgeon. He said the oral surgeon does not want to take the implant out and thinks we should just treat this with antibiotics. I have been on so many antibiotics and it isn't helping. The ENT is recommending that I have the implant taken out. He said that the oral surgeon is out of his comfort zone with this bone infection. So they are sending me to an infectious disease doctor to take care of the bone infection. But the ENT says that it will be easier to treat without the hardware of the implant. He said if it was him, he would take the implant out. Now I did voice my concern about the oral surgeon and he suggested I stay with the same one because he knows what he did when he put it in. My guess is that the 2nd oral surgeon doesn't want to get involved. This is a giant mess and all I want to do is feel better. Do you have any advise? I have a call into the oral surgeon now.

Angels,

I have been saying from the get go that it's complicated but your oral surgeon kept making it seem like there was nothing wrong. Then to make matters worse he scares you into doing the implant. Even now, he fails to admit the seriousness of the situation. It is not in your best interest to keep the implant and just keep taking antibiotics because you can end up with major health issues as well as intestinal problems that can be very difficult to eradicate.

In my opinion, the oral surgeon is caught between his ego and the money he has been paid and doesn't want to admit his role in this nor lose a dime.

Regarding the removal of the implant ... If "he" removes the implant "now" then without question he should reimburse you and your insurance for all the monies he received pertaining to the implant surgery. He also should not charge you to remove the implant. However, if he can convince you to keep the implant for 6 months to a year and then remove it, even though that is not in your best interest, then he can argue about not being obligated to give any financial reimbursement because of the amount of time that had transpired.

If another oral surgeon removes the implant he will need to have...

ALL of your xrays and scans from the other surgeon.
ALL of your chart notes and surgical reports from the other surgeon.
He will also charge you to remove the implant and perform whatever other surgery needs to be done. Your insurance is not likely to cover any of that cost if there is little to no money left in your yearly allowable budgeted amount.

If the original oral surgeon is not willing to reimburse you and your insurance company, irrelevant of whether he is the one to remove the implant, then you will need to write to your insurance company telling them...

**That the implant was placed in infected bone as confirmed by the recent MRI.
**The oral surgeon refused to remove the implant and you had to seek another oral surgeon to remove it.
**You want the insurance to bill the oral surgeon for reimbursement of the money they paid him for the implant and bone graft surgery. This will put money back into your insurance account to be used for other dental work.
**You then want the insurance to consider paying the fee for the removal of the implant by a different oral surgeon.

The reason the ENT is suggesting that you stay with this oral surgeon is not because he thinks he's going to do right by you, but because he knows that any other surgeon is going to be hesitant to get involved in this case. Why? Because there is a chance you may have to consider taking legal action against the original oral surgeon. Especially if he is not willing to reimburse you and your insurance company.

Another oral surgeon will be able to remove this implant. Having the xrays, scans, charting and surgical reports are all very helpful and necessary as they give the history of what has taken place and the particulars related to the bone graft materials and type and size of the implant that was placed. However, the surgeon will not know the extent of the infection until he gets in there.

An infection disease specialist should get involved as I mentioned to you in a previous note because this is a difficult infection to manage. However, treating the infection while keeping the implant could be detrimental to your health in more ways than you know.

Angels, I would be hesitant to have the original surgeon do any further surgery. He has built a shaky history with you and just does not seem to have your best interests before his own ego or wallet. That's how it looks to me and I've seen it many times before.

Bryanna







QUOTE=Angels31;1220594]Hi Bryanna,
This is a little more complicated than I thought. The ENT just called me and told me he spoke to the oral surgeon. He said the oral surgeon does not want to take the implant out and thinks we should just treat this with antibiotics. I have been on so many antibiotics and it isn't helping. The ENT is recommending that I have the implant taken out. He said that the oral surgeon is out of his comfort zone with this bone infection. So they are sending me to an infectious disease doctor to take care of the bone infection. But the ENT says that it will be easier to treat without the hardware of the implant. He said if it was him, he would take the implant out. Now I did voice my concern about the oral surgeon and he suggested I stay with the same one because he knows what he did when he put it in. My guess is that the 2nd oral surgeon doesn't want to get involved. This is a giant mess and all I want to do is feel better. Do you have any advise? I have a call into the oral surgeon now.[/QUOTE]

Hi Bryanna,
I have a couple of questions. What do they put in when they take the implant out? Do they put another bone graft? Nothing? Also, how come my bone infection didn't show on a CT scan? The second oral surgeon I went to is highly respected and also an MD. You would think he would have seen it? The first oral surgeon has not returned my call. I know you are right about the ego and greed. You have been right about this whole thing all along.

Angels,

The implant is removed, the jaw bone and sinus are surgically debrided of all visible infection, necrotic tissue and bone. This surgery NEEDS to be very thorough and meticulously done. It cannot be done quick or carelessly. Sometimes there will be an opening into the sinus which may or may not be able to be repaired during this surgery. That may require a different surgery. It all depends on how extensive the infection is and how thorough the surgeon is able to perform the surgery. Bone grafting is not usually put in at this surgery as there could still be microscopic areas of infection which would hopefully be taken care of with the antibiotics. The antibiotics need to be specific for the type of bacteria that is causing the infection. A clean specimen of the bacteria should be taken at the time of this surgery and sent to a pathologist for culturing to determine the proper antibiotic. This is a CRUCIAL step and should be done.

This bone infection is long standing... it began as far back at the root canal therapy. It may not have shown on the CT scan as definitive infection or the angle of the scan was off... there are a number of reasons why it was not picked up. It could also be that is was visible but misdiagnosed as graft material.

The second oral surgeon is a better option to see for the removal of this implant ..... not the original surgeon. Please, think twice before letting the original surgeon do any further treatment.

Bryanna

Hi Bryanna,
Both the ENT and second oral surgeon have told me that I need to have the original oral surgeon take out the implant. He is going to do just that, he isn't going to do a big cleaning and surgery. I am having a heck of a time. The infectious disease doctor can't see me until October and the ENT is not willing to help me get in earlier, they told me that I would need to,go to the ER to get in earlier. I believe this implant is making me sick and I really need it out. The second oral surgeon said it should be easy to take it out because it has only been 2 weeks. I really feel like nobody cares and I am on my own fighting for everything. I am so confused, I have an infection in the bone but I have to wait two months to be seen? This is beyond frustrating and yes I am very uncomfortable having the first oral surgeon take it out especially when he told the ENT this bone infection is out of his comfort zone. He wanted to treat this with antibiotics, but what he doesn't realize is how long I have been on antibiotics. I am bringing a list with me from the pharmacy to show him.