Extraction and Implant, soooo Scared!!!
 

Hi all,

Next week I am having tooth #20 extracted due to internal root resorption and hopefully my implant done on the same day. I have done a year and a half of research and found one of the best periodontist here in the area so I feel really comfortable with my DR. With that being said I am just sooo nervous about this procedure. Can anyone chime in here on what I can expect after?

We will be doing the extraction and there is an 80% chance she can do the implant that day along with the bone graft that she says is pretty typical for implants. Due to my age (34) and how healthy I am, nonsmoker, and the fact that there is a good amount of bone, she feels she can do the implant that day. She also mentioned that the root tip is curved and there is a possibility that if it breaks she may not be able to get it out since it is so close to the nerves in that location. Is this typical? What can I expect if it does break?

So how much pain am I going to be in? When can I expect to resume normal activity? Yes, she has answered these questions for me but I would like to hear an honest answer from someone who has been there or someone that will be straight with me about it.

Any advice would be great! Thanks!

I don't remember everything, but
 

I had 2 implants done four years ago. The molars were already gone, so there was no extraction to worry about, but I do remember that the implants took several visits to accomplish. It wasn't all that painful, and I had two done, side by side. I also remember having the metal posts put in right before I started a new job, and I don't believe I had all that much pain. Sorry I can't remember more...

By the way, the implants are great - no problems whatsoever!

Thanks for that reply Jacquie. I have heard the extraction is harder then the implant, and since I am having both done or at least the extraction for sure, that is what I am most concerned about. I have had my wisdom teeth out but that was 15 years ago and I dont remember any problems with that, except the dry socket I developed, but other than that no problems. I wonder if this will be similar?

Hi ellem,

You mentioned that you did alot of research to find this dentist. Did you research her credentials and reputation only OR did you research dental implants also?

I'm in the dental field 30+ years and feel compelled to share a few things with you based on what you have written here. I know you want to believe in this dentist and she may be a great periodontist! So my intention is not to discredit her in any way .... it's to help you become better informed.

The success of a dental implant depends on several things. Such as the patients overall health/medications; their oral health and oral hygiene; eating habits; lifestyle smoking/drinking alcohol; size/shape/thickness of the jawbone; and the health of the jawbone that the implant is going into.

With that said, it is not ideal to place an implant in the bone where there is an irritant such as a broken root tip. Root tips are a foreign body that often become infected. If that were to happen, then the implant would be compromised. At the same time, it is imperative that should the root break, it is removed properly to avoid traumatizing the nerve.

It is imperative that the surgical site for the placement of the implant be free of any possible irritants and be kept sterile during the entire procedure. A slight contamination can compromise the integration of the dental implant.

I am mentioning this to you because rather than her dismissing or making light of this issue about the root tip breaking off, perhaps she should have informed you of the possible consequences.

My dental experience is saying..... she is not confident in removing this tooth because of the curved root. In case you are not aware, generally, periodontists do few extractions and hesitate with extracting teeth that are likely to pose a problem. However, all too often the dentist knows if she were to have this tooth removed by an oral surgeon, then she would most likely lose out on placing the implant to that oral surgeon if it were to be an immediate placement.

Have you gotten other opinions from other dentists about the removal of this tooth? Is it possible to get a second opinion say from an oral surgeon?

To answer your question about post operative issues after extraction and implant placement....... I have had teeth extracted but have never had an implant. I have assisted on many of these procedures and can say that it is important to follow the post operative instructions to the T that are given by the dentist. Following them will diminish the pain and speed the healing. Being well prepared with a soft, healthy diet beforehand will also help. Keep yourself hydrated with water.... no soda or sugary foods as these slow down the healing process.

I hope not to alarm you........ this is a difficult decision to make and it can be scary. I'm just here to offer you my opinion based on my professional experience.

Perhaps you could have a phone consult with her about how often she extracts teeth with curved root tips and let her know you are concerned?

Bryanna

Hi Bryanna,

Everything you have mentioned are things I did consider and were concerns of mine, and actually still are. I did research both, the dentist and implants.

Let me give you a little background. I take very good care of my teeth and gums. My gums are in great shape but I do clench my teeth so they have taken a little bit of a beating from that but I have worn a flat plane night guard for the last 10 years. I have a prosthodontist that handles all my restorations, an endotontist that has done my root canals, (I know how you feel about those and it has me scared to death) and a periodontist. I do have a high amount of respect for my endo though. He is actually very against doing any procedure unless it is absolutely necessary. Even root canals which is his job.

I did interview 3 perio's before I chose the one I am using. I also considered an oral surgeon but I was told (by my endo) that since perio's specialize in soft tissue they are the best to use for the extraction and implant. I was told by all three perio's that they try to do the implant at the time of extraction depending on the patient. I did also check with my prosthodontist about the removal of this tooth and asked him how difficult it would be, since he has done a lot of extractions and he thought she would be able to remove it no problem.

When she mentioned the root to me this is what she said. "If the root tip breaks off we may have to leave it. In my opinion I feel it is too much of a risk and could cause damage to the nerve, trying to retrieve it." she also said she will really take her time with the extraction, but the problem is that with the resorption, the teeth tend to "pop" while you are trying to remove them, since they are hollow inside. She does 200 implants a year. I didn't ask how many extractions she does, I didn't think to. I just assumed she did a fair amount. I can call her on Monday and she will answer any questions I have. She is very good about that. My surgery is scheduled for Tuesday.

Here is what I have read and been told.

1. It is better to have the extraction, let it heal, then have the implant, but 3 perios have said they try to do it at the same time if possible.

2. Oral surgeons specialize in removing teeth, especially difficult ones, but perio's are the soft tissue guys.

3. Leaving a root tip in can cause an infection. And implanting on top of that can be disastrous. But, removing it can cause nerve damage.

So should I just plan on talking to her on Monday and depending on her answers consider postponing and getting an opinion from an Oral Surgeon? The tip is very close to the nerve. I have an x ray that I was going to attach but I guess I cant until I get to 10 posts. :(


Thank you so much for all your help. I just want to make sure I do everything the best way possible and I get the best treatment out there. It can just be very confusing when you get conflicting answers sometimes and when dentists are trying to make money! lol

One last question about the pain. Can I expect it to be really sore, or more throbbing? I just want to be as prepared as possible. I have all my soft foods ready to go and filled all my prescriptions today. I plan to follow all the directions I am told so hopefully I will heal fast!

Elle

Hi elle,

I knew by your post that you have done lots of research and are not new to having dental work. I think it is wise to check out a dr as much as possible ahead of time. However, what I know about dentistry comes from the "other side of the chair" in addition to being a patient. Just like a nurse would know more about "the other side of hospital care" moreso than I would. Obviously you seek the best as much as you can and remain concerned because of conflicting things that you have read. Well the best informed patient is always skeptical because there is no such thing as perfect, IMO.

Endodontists who tell people that they only treat the teeth that should be treated are only telling part of the story. In other words, along with that statement they also, in my opinion, should be informing patients about the systemic connection between our teeth and overall health. It is only fair to tell the whole truth about the root canal procedure to the patient so that the patient can make an informed decision as to what they feel is in their own best interest. Treatment options should be given to every patient.

It's been my experience having worked in oral surgery, perio, prostho and general dentistry that periodontists and prosthodontists do the least amount of extractions. Periodontists, Prosthodontists and general dentists all have the exact same training in oral surgery. Their expertise is in other areas of dentistry. Like in any profession, some are better at certain things than others. Some perio or prostho's may be good at doing extractions, but more times than not tooth removal other than those considered "easy" are not their typical clincal experience. Now perhaps your periodontist does alot of extractions for some reason? If so, then why would she even entertain the idea of the root breaking off and tell you before it even happens that she's not going in to get it?

I know what I am saying is scaring the bageebers out of you and I am so sorry for doing that. But I have seen this situation too many times and it is not a good idea to leave a root tip in the jawbone. Especially when doing an implant there. As a matter of fact, if a root tip is left in the jawbone at an old extraction site........and the patient is now going to have an implant put there....... the surgeon removes the root tip before placing the implant. Why? Because that root tip is a potential source of infection. For a dentist to tell you any differently they are simply not telling you the truth.

Copied from your post...Here is what I have read and been told.

1. It is better to have the extraction, let it heal, then have the implant, but 3 perios have said they try to do it at the same time if possible.
YES, IT IS IDEAL TO HAVE THE EXTRACTION AND LET IT HEAL. THEN 3-6 MONTHS LATER GO IN AN PLACE THE IMPLANT.

2. Oral surgeons specialize in removing teeth, especially difficult ones, but perio's are the soft tissue guys.
OS'S SPECIALIZE IN OS ABSOLUTELY. SOME ARE A BIT TOO AGGRESSIVE AND THAT IS WHAT YOUR PROSTHO WAS TRYING TO SAY TO YOU WHEN HE SAID THE PERIODONTIST HAS A DIFFERENT APPROACH. HOWEVER, IF THE OS KNOWS THAT THE JAWBONE IS GOING TO BE RECEIVING AN IMPLANT, THEY TAKE BETTER CARE OF IT DURING THE EXTRACTION. PERIODDONTISTS ARE DEFINTIELY MORE CONCERNED ABOUT THE SOFT TISSUE AND TREAT IT VERY GINGERLY WHICH IS GOOD! BUT YOU NEED TO BE ABLE TO ELEVATE A TOOTH EFFECTIVELY AND HAVE THE PROPER INSTRUMENTS TO RETRIEVE ANY PEICES OF TOOTH THAT BREAK OFF. MY CONCERN WITH YOUR PERIO IS IF HER ATTITUDE IS I'M JUST GOING TO LEAVE IT THERE, THEN SHE MAY NOT HAVE THE SURGICAL INSTRUMENTS TO RETRIEVE IT.

3. Leaving a root tip in can cause an infection. And implanting on top of that can be disastrous. But, removing it can cause nerve damage.
YES, A RETAINED ROOT TIP IS A POTENTIAL SOURCE OF INFECTION. PLACING AN IMPLANT NEAR AN IRRITANT IS 100% AVOIDABLE. REMOVING A TOOTH WITH A CURVED ROOT TIP NEAR THE MANDIBULAR CANAL (THE NERVE SHE IS REFERRING TO) SHOULD ONLY BE DONE BY A DENTIST WHO HAS DONE MANY, MANY HUNDREDS +++ OF THEM. ANY DENTIST COULD BREAK THAT ROOT TIP OFF..... BUT THERE ARE INSTRUMENTS AND TECHNIQUIES USED TO RETRIEVE IT WITHOUT CAUSING NERVE DAMAGE. USING AN IMPROPER INSTRUMENT CAN ACTUALLY PUSH THE ROOT TIP FURTHER INTO THE NERVE CANAL AND THEN THE DAMAGE AS OCCURED WHETHER IT IS REMOVED OR NOT.

With reagrd to your pain question...... everyone is different. Depending on how difficult the extraction is can determine the soreness. Implant placement generally does not cause throbbing pain. Various degress of achiness, soreness, and swelling can occur.

Again, I think you are doing an awesome job of doing your homework!!! I so encourage people to do what you are doing! But some people are more comfortable with just putting their trust in the dr and don't want to think about the what if's and that's fine. But the dr should still inform the patient as much as tolerable. Me...... I'm a what if person because I have seen and experienced too much to know better.

Let us know what you decide to do...... I think it would be wise to go with your gut instint on this one.

Bryanna

Hi Bryanna,

Well I rescheduled with my perio for the first week of March. I did get a chance to meet with her today and ask her some of the questions we discussed.

1. She does about 500 extractions a year. I don't know if that is a lot based off industry standards, but it sounds like a lot to me. She just recently did a free clinic where she pulled about 100 teeth in one day. It was for people who didn't have ins. She did say that if I felt better going with an OS that was fine and she would have no problem doing the implant after wards.

2. There have only been 2 instances in her 15 years of practice where she has not been able to extract a root tip. She just wanted me to be aware of the potential problem in case it happens. Especially since she knows this tooth will crack to pieces once she starts to remove it and that makes for a more difficult extraction, but she is pretty confident she will be able to extract it.

So that is where I stand for now. I feel good about using her, and I feel that she is confident that she can remove it, and I am confident she can remove it.

I will check in again and update the thread for anyone in the future, and let you know how the procedure goes. Hopefully no problems! Thanks for all your help. I really appreciate you taking the time to answer my questions.

Elle

Hi Elle,

Thanks for posting today. I was wondering what you had decided to do.

Five hundred extractions a year is quite a bit for a periodontist. However, most of the patients that are seen by a periodontist have gum disease which means they have various degrees of bone loss. So how many of those extractions were clinically difficult? Of course only she would know that answer. The free clinic that she did sounds very impressive..... but to remove 100 teeth in one day means either the teeth were basically falling out on their own, or she did full mouth extractions (multiple teeth on one or more patients) and/or she didn't take much time with each extraction. I'm just playing devil's advocate here...... 100 teeth in one day??

It also sounds impressive that she's only had 2 teeth in 15 yrs where she was unable to remove the root tip. But again, it is never ok to leave a root tip. I have worked for 6 dental practices in 30+ yrs, some mutli doctor offices, only once have a assisted a dr who left a root tip in the jawbone. Several years later this patient came in with a sore gum...... the root tip made it's way to the gumline and was removed. NO residual infection but also no dental implant to contend with.

Even the best dentist can have difficulty with an extraction. There are so many factors to take into consideration and no one is at their best all of the time. My concern with this periodontist is her initial statement to you about not retrieving the root tip and how that would not cause a problem in the future with the implant. As to her skill and technique, she may be awesome... or just as good as someone else. This is the chance we all take when we have a tooth pulled by anyone.

I wish you all the best and truly hope that the surgery goes well! Please do keep us updated!

Bryanna

Thought I would drop in and give an update. I had the procedure done yesterday and I am feeling really good! I am surprised at how little pain I am in. I just feel a little sore, but nothing more. I havent taken any pain pills, just Tylenol and Advil and I am not even sure that I need that but will continue for a few days just in case. I am following all the directions. Rinsing with warm salt water, and using the Perodex rinse as well. Hopefully it just continues to get better!

Hi elle,

Great to hear that you're feeling so well!

So was the dentist able to remove the entire tooth and place the implant immediately?

If the OTC pain meds are working for you, than that is probably all you will need ;-))

Bryanna

Sorry I was in a bit of a hurry yesterday when I posted and didn't get a chance to give more detail.

She was able to remove the entire tooth. The root tip didnt break off and the tooth came out in one piece. She told my husband it was an easy extraction, and a simple implant procedure. She said it was textbook, or something along those lines. So yes she did place the implant right away.

I could see the implant the first day but now it seems to have covered up a bit. I guess once the stitches dissolve I will be able to see more. I am trying to be really careful about eating and not get food on that side but I am sure stuff just ends up over there. I am not messing with it at all! Just doing my salt water rinses and staying on top of my medication. Everything is still feeling really good. I only took 2 advil today and that was more for a headache then anything else.

I guess my only concern at this point would be a dry socket/infection and the implant setting into the bone. I have my check up on March 22nd so we shall see how things are going, but I am hopeful! Sooo happy to have this behind me. Thanks for all your help!

Hi elle,

Very relieved to hear that she removed the entire tooth and that the procedure went well!

There may be some swelling in the gum area over the top of the implant which would make it difficult to see it...... that is normal and will subside in a few days.

It is important to continue the salt water rinses and to avoid eating anything on that area for the next few weeks at least.

You won't get a dry socket because the area of bone that held the tooth is filled up with the implant. So the clotting factor is very different with this type of surgery compared to if you just had the extraction alone. Infection is always a concern with any oral surgery but it's not necessarily more of concern just because of the implant placement. As long as the socket was debrided properly, the bone receiving the implant was healthy, everything was kept very sterile, and your body accepts the implant, you should have a positive outcome!

Did she add bone graft material? How would you describe the experience of the actual placement of the implant?

Bryanna

Hi Bryanna,

Yes she did add bone graft as well. At least that was the plan and I cant imagine that she didn't, but I was sedated and she didn't tell my husband otherwise so I would assume she did. I will find out for sure in a week when I go for my check up.

As far as the whole experience. I was sedated with Halcion. I don't like being sedated but I didn't want to know what was going on. I do remember bits and pieces but I didn't "feel" anything. I knew when she was working on the extraction, but I remember nothing from the actual implant part. I think I totally blacked out during that because I do remember the end when it was time to go and seeing my x-ray with the implant placed. Looking back now I may prefer to not be so sedated. I felt so much better once I came around later that day. I just don't like that feeling of being "out".

Hope this helps someone else to know what to expect.