Sinus lift, debriding, bone graft
 

Hello everyone,

I've visited this forum in the past and found very helpful answers.
This is my first post, I hope someone can enlighten me.

One of my upper left molars (sorry, no idea about teeth numbers) had a long nasty history. It was first root-canaled, badly, by a dentist about 30 years ago (I am now 47). Then it broke, root-canaled again, whole fake tooth placed over the roots... years later that came off, a dentist just stuck it back on badly. Eventually one of the roots cracked.... infection followed etc. Long story short: in May 2015 I had it extracted. I took antibiotics and my usual dentist said it will now be fine.

About 2 weeks ago I went to a specialist to start the implant procedure. I already knew the first stage would be a sinus lift and bone graft. However, when the surgeon opened it up, he said that the infection in the bone was still there, and it can't go away unless he debrides it (which he did). He did everything in one go - sinus lift/debriding/bone graft, and in the end he put some stitches on (it all took 2 hours!).

After 1 week the gum got somehow torn, and he needed to add a couple more stitches. All along, since the day of the procedure, the surgical site smells very bad. I took Augmentin for the first week, now I'm on Metronidazol (3rd day now). I was told to brush teeth, but nowhere near the site, and rinse only with Chlorhexil.

My questions are, a) I still feel some threads hanging... is it possible I need yet more stitches?, and b) are there any chances of success for this bone graft? As, from what I read on this forum, it's bound to fail (due to bad history, and debriding/graft done at the same time).

Many thanks in advance to anyone who took the trouble to read this and to anyone who replies.

rose8,

Sorry to hear you are having such a problem with this area of your mouth. It is typical for a root canaled tooth to infect the jaw bone and it is also common for the jaw bone to need a second debridement because the infection from that tooth can be very stubborn.

<<a) I still feel some threads hanging... is it possible I need yet more stitches?,>>

AS THE SWELLING OF THE TISSUE RECEDES, THE SUTURES WILL BECOME LOOSE. IF THEY ANNOY YOU, SEE THE DENTIST TO HAVE THEM REMOVED.

<< b) are there any chances of success for this bone graft?>>

THE SUCCESS RATE OF A DENTAL BONE GRAFT IN AN AREA OF THE JAW BONE THAT ONCE HAD A ROOT CANALED TOOTH IS LESS THAN IF IT WERE PLACED IN AN AREA OF BONE THAT DID NOT HAVE A ROOT CANALED TOOTH. THE REASON BEING IS DUE TO THE LOSS OF THE INTEGRITY OF THE BONE FROM THE INFECTED TOOTH AND FROM POSSIBLE RESIDUAL INFECTION THAT IS NOT CLINICALLY OR RADIO GRAPHICALLY OBVIOUS. ANTIBIOTICS ARE NOT ALWAYS SUCCESSFUL AT CLEARING THIS TYPE OF INFECTION. THE DENTIST CANNOT DETERMINE THE EXTENT OF THE BACTERIA UNLESS IT CAN BE DIAGNOSED CLINICALLY OR RADIO GRAPHICALLY.

<< As, from what I read on this forum, it's bound to fail (due to bad history, and debriding/graft done at the same time).>>

THE GRAFT IS NOT BOUND TO FAIL. IT IS AT A HIGHER RISK OF FAILURE DUE TO THE REASONS I HAVE OFFERED YOU. ROOT CANALED TEETH ARE A CHRONIC SOURCE OF INFECTIOUS BACTERIA. THEREFORE, THE LIKELIHOOD OF RESIDUAL BACTERIA RESIDING IN THE JAW BONE INCREASES WITH THE THE LENGTH OF TIME THAT THE RC TOOTH IS PRESENT.

Are the teeth adjacent to this recently extracted one also root canaled?

Bryanna





I will re post your questions and answer in bold type...

Thanks so much for the thorough and detailed answer Bryanna, much appreciated!

In the end I didn't need extra stitches, it was what you said (some had come loose).

One of the adjacent teeth was root-canaled a couple of years ago - the other adjacent tooth is totally healthy. What you wrote totally makes sense - so I'll be extra careful, keep an eye on everything, and keep fingers crossed.