I think someone posted something similar recently but just was wondering if anyone got any answers:

I had tooth #26 (lower toward front) extracted after infection (I had a root canal on the tooth for over 20 years, bit something hard and must have caused a chain reaction). The site was bone grafted and after 4 months I tried getting an implant which failed after 10 days, the oral surgeon did not understand why and so no signs of infection. I tried inserting the implant again and so far I am along 2 weeks along and everything seems OK so far (I am thinking the flipper I wore on the site caused undue pressure before). However there is a hard bump in the gum, below where the tooth was. I asked both my oral surgeon and dentist about this and they said it wasn't anything to worry about, that nothing was showing up in the X-ray. The oral surgeon said that it was part of my chin bone (sure doesn't feel like it because it's not that way on the other side of the mouth).

I am wondering if there was a cyst there, or infection, would it be possible that it would only show up in a more advanced scan? My oral surgeon is not equipped with anything besides a panoramic x ray machine.

jenny,

In the lower front area of the mouth the jaw bone is by nature very thin and narrow. A long standing infection, which is what you had with your 20 year old root canaled tooth, eroded the jaw bone thus compromising the integrity of the bone. Bone grafting in this area is tricky even if the bone had been healthy. The greater the loss of bone, the higher the risk of failure with the graft and the dental implant.

Bone graft material does not provide new jaw bone. It is surgically placed to encourage the body to grow new bone cells which integrate with the graft material until the new bone becomes solid. However, bone grafts need to be placed "inside" of healthy bone in order for the cells to grow. If there is inadequate healthy bone and the graft is placed next to or on top of existing bone, little to no integration will occur. The graft would then be similar to a pebble sitting in the tissue that it was placed in. In those cases, the graft can be palpated or felt on the outside of the gum in the area where the roots of the extracted tooth use to be. The long term success rate of this type of graft and even the dental implant would be very low.

When there is less than adequate bone or very thin bone, the implant may not be surrounded by bone. In that case, the bump that is felt in that gum area can be the actual dental implant.

If the lump were your chin bone.... it would not feel like something new to you as nothing was altered regarding your chin. Right?

The lump could also be a cyst that is not being diagnosed.

Routine dental xrays and panoramic xrays are 2 dimensional and are limiting for a proper diagnosis in cases like yours. You would need to see an oral surgeon who has a 3D dental scan machine which would give a broader view of that area.

I hope this information is helpful. Let us know how you're doing.
Bryanna

Thank you for your reply! What you wrote here sounds like it could be my case. The bump is near where the tooth's root would have been, its in the lower gum next to where the mouth meets the gums. I had the bump there after the extraction, prior to when the implant was placed. It is not painful but it can definitely be felt. My oral surgeon kept telling me the bone looks good (again basing it on xray). I also mentioned this to my general dentist and she said something like, sometimes this can happen with the root of a tooth is removed.

Does this mean there is a lingering infection and that this needs bump/graft to be removed, as well as the implant?

jenny,

It means that the problem needs further evaluation AND the sooner the better just in case the implant needs to be removed.

You need a 3D dental scan. Ask you oral surgeon for a referral to a colleague who has that machine.

Bryanna

Hi Bryanna. I just wanted to follow up on this. Last month I was supposed to get the crown on the implant however I still get occasional twinges of pain and pressure in the area so I went back to my oral surgeon. He insisted the X-Ray looked good but referred me out for a 3D ct scan place to get a scan done for my peace of mind. I had the scan done last month and the OS said that the 3D scan looked good, and to get the crown done. He said the "bump" under the gum below the implant is just bone. I have an appt to get the crown done in about two weeks however I still get the occasional bothersome pressure/pain (also had some pain in the gum two teeth down, under the pre-molars, which so far went away), something to me just doesn't feel right... I made an appt for next week for a 2nd opinion with another OS to see what they say, but I had a question... Is it possible that teeth clenching can cause some pain/discomfort? Something I notice that I do is clench my teeth at night so I wanted to know if this was a possibility of what could be causing the occasional discomfort.

Just wanted to update in case anyone is questioning anything go with your gut... I sought a second opinion from another OS after being given the run around from the one I originally saw- The new OS office was 100x better, should have went here to begin with. This office was equipped with updated technology. He did do a 3d scan of my implant but is sending me to a radiology place to do a CT scan.. .he is suspecting osteomyelitis... I looked this up and it is scaring the heck out of me....