Jaw Bone Infection
 

Ok so I had an infection some 25 years ago in upper right number 2 (when I was 15 years old) and had a procedure that I now know to be an Apicoectomy.

I remember on and off having a bubble on the gum, and in the last few months I felt some ache in that area. Visited the dentist and had x-rays to be told that I had an infection on the jaw bone and no alternative but to extract.

Had the extraction today - dentist said it was quite a bad infection but was "self contained in a ball" and all infection got removed.

The front bone was gone all together but the other 3 sides were good, and apparently I might be ready for implant in 6 weeks. They said no anti biotiocs required.

so - the only thing I am concerned about is that the infection is gone - can it all have been in a ball being sucked out?

Hmm if the infection was that bad, I have to wonder why antibiotics were not given with the extraction?

Hi Sheepie,

I am in the dental field and can offer you some help here.

Something you may or may not have been told is that the bubble on the gum that kept occurring was actually caused by the bacteria spreading from the tooth into the jaw bone. The bacteria burrowed a path through the bone and out through the gum. This would release the pressure from the infection and inflammation. if the bubble had not occurred, the area could have swelled up quite large and been quite painful.

When there is a severe long term infection in the jaw bone such as yours, the bone decomposes from the infection and this can be very difficult if not impossible to rebuild. Also, in order to do an apicoectomy procedure a portion of the bone is permanently removed in order to gain access to the root of the tooth. So this needs to be kept in mind since you are considering replacing this tooth with a dental implant.

You wrote <<<The front bone was gone all together but the other 3 sides were good, and apparently I might be ready for implant in 6 weeks. >>>>

Three issues you need to be aware of based on that statement...

The front portion of the bone is called the buccal plate. This bone is the ridge that holds the frame of bone together. Without that bone, the framework collapses. When that portion of the bone is destroyed it does not grow back and cannot be filled in with bone graft material. Therefore to have an implant placed in that site would mean that one side of the implant would only be held in with gum tissue. This is definitely not ideal to say the least. These implants frequently fail.

Second it is never a good idea to place a dental implant 6 weeks post op extraction of posterior teeth as only a very minimum of bone has filled in within that short time frame. The least amount of time to wait post extraction is 3-4 months...minimum. Best to wait 6-9 months to give the bone a chance to fill in so the implant has something to integrate into.

Third, in your case the infection was severe and long standing. There is no way for the dentist to know if he was able to remove all of the infection or not as he could only remove what he could see and feel. It would be wise to have this area x-rayed at 3 month intervals for the first year to check the health of the bone and to see the progression of the growth of bone.

Regarding the infection being in ball, I find that hard to believe. If this had been an acute infection with a short duration, maybe that would hold true. But this area has been infected for 25 years and severe enough to destroy the buccal plate. I think a second opinion from a different oral surgeon would be warranted before you allow anyone to place an implant there.

It is always wise to proceed cautiously whenever you have a bone infection.

I hope information was helpful to you.
Bryanna

Thanks for the reply Bryanna

Before the tooth was extracted they told me it would be at least 4 months before it would be ready for an implant (based on x-rays). During the extraction they cut open the gum (at the front) so they could get a better look and then said it could be 6 weeks as it looked a lot better than they thought.

The surgeon specialises in dental implants and apparently "From 2006 to 2012 he was a tutor in Implant Surgery".

They also checked the teeth either side (x-ray) - both healthy and no signs of infection.

I guess I am going to have to wait and see....

At the moment my main concern is that all the infection is removed. It sounds like it was all at the front of the tooth, where the buccal plate should have been.

They want to see me again next week, so I'll get my questions ready!!

Hi Sheepie,

Yes, I understand. Nice that your surgeon is experienced in implant dentistry. However 6 weeks is way too soon as the bony socket will not have changed much in that time frame. Bone takes months to fill in and all dental implants need healthy, adequate bone to hold them in place. You are a high risk for implant failure due to the missing buccal plate .... add to that inadequate bone formation in the other areas and that can spell only one thing... failure. I've seen this same scenario hundreds of times because dentist and some patients are too eager to place the implant. As the saying goes.....haste makes waste!

Hope you are doing well!
Bryanna

Thanks Bryanna-I always learn so much from you!

Hi socasusie,

Yea, probably more than you'd like to :/ But I believe people deserve to be told the facts so they can make an informed decision about their health!

BTW..... how are you feeling??

Bryanna

I'm so much better! No more pain at all. I think that bone fragment was making my mouth unhappy....

Yeah, but it's knowledge that applies to everyone, so it's good knowledge to have!

I concur, thank you Bryanna :)

UPDATE:

had an appointment with the dentist yesterday. Said extraction site is healing nice, no sign of infection (although I did start amoxicillin 500mg 3 days ago).

During the extraction, he looked at the bone and said it was very good on 3 sides but the labial plate had been lost due to the infection.

He says that given the bone is good on 3 sides, it is best to place the implant after 6 weeks before too much bone resorption, and to place grafting material (not bone) at where the labial plate should be. I guess it will be some months before the implant will be able to take any load.

I think the labial plate has been missing for many, many years as that tooth was always slightly loose and could be moved maybe 1mm in a forward/back direction for as long as I can remember.

I have a temporary denture (plate) but I am struggling to use it as the plate feels horrible. Are there any better solutions?

Got another appointment in 2 weeks time..........

I should also mention that the tooth is a upper lateral incisor (the dentist calls this #2 during checkups but it's probably #7 or #10).

Hi Sheepie,

Once again I will say that placing a dental implant in a site where the buccal/labial bone was destroyed by an infection is very risky. Grafting the buccal plate can be done but it generally doesn't hold up for any long term. Esthetically recession will occur along the buccal margin meaning the gum will shrink back along the buccal side and will be raised higher than normal most often exposing the dental implant.

Grafting material is bone or a calcium substitute. The intention of placing that is to encourage new bone to grow into it but it does not become bone on it's own therefore it needs to be placed into existing bone not on top of or next to. The buccal plate does grow back and the dentist is relying on the graft to hold the implant. The graft can not become bone as it will only be sitting in soft tissue. So you will end up with an implant that has no bone across the buccal side of it.

Yes, cases like yours are being done all of the time. Not with much success due to many factors but mainly to those that I have told you about. Your dentist should be informing you about the reasons why this approach is not ideal so that you can make an informed decision about whether or not you believe it to be in your best interest.

Perhaps seeking another opinion from a different oral surgeon may be wise. :)

Bryanna

Hi Bryanna

thanks for the reply.

What would you suggest it the best course of action here? The teeth either side are in good condition which is why I don't really want to risk damage to them with a bridge. I am not sure there is enough of a gap in my bite for an adhesive bridge.....

If the implant does fail then what does that mean, I guess it can be removed etc and I'll be back to square one but at a cost.

The temporary denture is just rubbish - it fits but I can't eat with it in, my lower front teeth hit the denture before the molars engage (if that makes sense!) so I can't chew right. I think I am going to have go back and get a new one now they can take an impression with the tooth missing.

I had this tooth (the extracted one) root canalled and apic by a regular dentist (not surgeon) about 25 years ago and I still remember it now. Thinking back I am not sure he knew what he was doing. A year later I had a similar problem with the other lateral incisor, and he then referred me to an oral surgeon. That tooth, although still infected, the infection has never escaped and I will now get regualr xrays and I will get the tooth extracted at the first sign of any infection in the bone.

Dental implants were never an option years ago - but these days people should be properly informed about infected teeth before having root canal, as I suspect most would go for extraction and impants if they knew.

Sheepie (I'm from Wales!!)

Hi Sheepie,

It is truly unfortunate that a dentist did not inform you much sooner about what was occurring in the jaw bone as it had to be evident on your radio-graphs and that little wiggle that you had with that tooth.... also indicated the bone was collapsing. This current situation was avoidable.... but only if you had been informed sooner and acted on it.

I'm telling you this because most dentists will ignore the signs of disease from root canaled teeth which misleads the patient to thinking the tooth is okay. It is only when the signs become too evident and widespread that the dentist acknowledges the problem.

There is no ideal answer to replacing this tooth. It is a shame to cut down adjacent teeth that are healthy to replace this one. You may be a candidate for a Maryland bridge which is a 3 unit appliance that has one fake tooth in the middle and is permanently cemented to the adjacent teeth by thin metal "wings" that go behind those adjacent teeth. The only other option is a removable partial denture which would be made a little differently than the temporary flipper that you currently have.

If the implant fails..... there would be additional infection in the bone which would need to be surgically debrided. The infection may or may not be obvious soon after the placement. Any jaw bone infection can compromise the other adjacent teeth. Bone infection also poses systemic risk for your physical health.

When a dental implant fails... sometimes the implant actually falls out on its own (still would need surgical debridement) ... sometimes it needs to be surgically removed. Sometimes the "wait and see" approach is taken as it is failing to see how long it will last before it needs to be removed. It is a huge investment in many ways. So be clear that this is the gamble you would be embarking on. The choice is totally up to you as only you can decide what is in your own best interest.

Regarding the appliance that you are wearing.... it is important that it fit properly into your existing bite and that you wear it during the day ... so it obviously needs to be adjusted. It is not designed to be worn when you eat most foods or wear at night while you sleep. It is for esthetic purposes and should be removed for eating and sleeping.

BTW... welcome from Wales!!!
Bryanna