Bone Graft for Front Tooth
 

Hello,
I had a front tooth extracted and a bone graft performed at the same time. This occurred about two weeks ago.
My dentist did not prescribe an antibiotic but I called him a week later because it was swollen and I tasted a weird taste in my mouth. He did prescribe an antibiotic.

Well he did not do the flipper tooth but used the extracted tooth. He used the cement and utilized the extracted tooth for cosmetic purposes.Therefore it is glued in place.

I'm concerned because my gum is dark in the area of the bone graft. Also when I went i this week for a follow up, he mentioned that we may have lost some of the bone due to the infection. Is this possible?
The bone or graft is poking through the gum. Therefore the tooth looks longer. My gum doesn't look really full. My gum looks like there is a slight ridge.
He mentioned I might need another graft in 3 months. I'm wondering if he did something that wasn't right. Besides I'm uncertain if I want to spend another $980 for a bone graft if it could have been prevented in the first place.
Does the information from the dentist sound right?

Hi Paulyfred,

I am in the dental field and can offer you some information here.
Thank you for posting the picture, it is helpful.

The tooth that was extracted, was that a root canaled tooth? If so, how long ago was it root canaled? Was there a fistula or pimple like bump above this tooth prior to having it removed?

The upper front maxillary bone is very thin compared to other areas of the mouth. If the extracted tooth had been root canaled or was infected, then there is a good chance that you have some bone loss in that area. Usually the area of bone that is lost in this area of the mouth is the front or buccal portion. Placing a bone graft in this area under that condition would be very risky because the graft would be sitting in more soft tissue than bone which means the graft would not have bone to integrate into. So if that is your case, then the graft that is not able to integrate with the bone is going to keep falling out and it doesn't matter how many times the graft is re done because if there is no buccal bone present now, there never will be as this area of bone is not replaceable without using a piece of your own bone that has been harvested from another area of your body. Even that surgery is not a guarantee to be successful. This area of bone loss would cause the gum tissue to recede upwards to meet the edge of the existing bone and to become indented where that buccal bone is missing.

It is normal to have some discoloration and inflammation of the gum tissue surrounding this extraction site but at this point it should have calmed down. The prolonged discoloration and inflammation can be due to infection, rejection of the bone graft, and/or the fake tooth that the dentist adhered to the adjacent teeth may be pressing too tightly against the surgery site.

I assume your dentist suggested to put a dental implant in this area at some point? FYI... dental implants require healthy, adequate bone in order to hold them in the jaw successfully. If the buccal bone is non existent then the dental implant will not be surrounded by jaw bone and that front portion can be somewhat visible through the gum tissue. This is something to discuss with your dentist prior to putting in an implant.

Are you seeing a general dentist for all of this oral surgery or an oral surgeon?

Bryanna





When an upper front tooth is removed

Bone Graft Issues
 

Thank you so much for the information.
There was infection at the site but I don't think it was present at the time of the extraction. I thought it was standard protocol to prescribe antibiotics when there is an extraction. None the less, there was a fistula at one time but not then.
I am planning on getting a dental implant when the bone is better.

However I feel as though the gum looked better a few days ago. I can see an indentation and discoloration. I didn't know if the darker gum was because I am ethnic although my other gum is pink.
It is not hurting and I am not asking anything unusual in my mouth.

The dentist did take X-rays and photos. He is a D.M.D. and he attended the University of Pennsylvania. He does have certificates for Implantologist. They do cosmetic dentistry, periodontal planning and restorations. However I do not know how experienced they are in this area. There are three dentist in the practice.
Do you suggest I seek out a periodontist which specializes in this area?

I am suppose to go back in one month but I'm getting worried. Any help is deeply appreciated.

Hi Paulyfred,

Thanks for posting these other pictures.

Unfortunately, the gum does not look good. It should not look that way at this stage of healing. It appears that the buccal area of bone is fragile if even present which could have resulted from the infection that was present before this tooth was removed. I am assuming it was root canaled awhile ago, is that correct? It had developed a fistula at some point in time prior to the extraction. Is that correct?

When a fistula develops above an infected or root canaled tooth it means that the infection has spread from the tooth into the bone. It takes time for the fistula to form and it can come and go. Generally the infection has to be present for quite some time before the fistula appears. The area of bone that the infection has traveled through to get to the outside of the gum through the fistula deteriorates and is usually not replaceable. It is possible this has occurred in your case and if so, then this area of bone may not be able to hold a dental implant.

Regarding the dentists credentials... a DMD simply indicates a general dentist. An implantologist certificate does not deem that dentist a surgeon. It just means he took a course or workshop and passed. His experience with dental surgery and implants may be minimal or may not be.

It is generally wise to see an oral surgeon for the removal of an infected tooth because they are more educated and experienced in oral surgery. They are also more educated and experienced with placing dental implants much more so than most general dentists.

This area should be clinically examined and an xray should be done to see the condition of the bone, the graft and whatever other the pathology is going on. Please consider seeing an oral surgeon especially if your dentist is not taking this seriously.

FYI.... The initial healing of your oral surgery is crucial for the overall healing as infection and death of bone or tissue can prevent the site from healing.

I'm sorry you are going through this. Please don't wait to have this checked.

Bryanna

Hi Bryanna,
Thank you so much. I'm not certain if he's not taking it seriously.
However I was concerned after reading online that for many people it was standard protocol to implement antibiotics which he didn't do. I has the tooth extracted and bone graft done on April 20 which was a Monday. On that Saturday I noticed it was red and puffy. I called his cell phone and he called in amoxicillin to the pharmacy. I took that for 6 days. I saw him that Monday and it did look better. However its got darker and has an indentation.

My dilemma is should I schedule with him to see what he wants to do? Or should I just scheduled with someone else and tell him I'm getting a second opinion.
Money is not an issue when it comes to my health. My dental coverage doesn't cover this anyway.

There is a practice that I had to take my daughter to for gingivectomy. They were excellent but very expensive.I am going to list their website so you can let me know if they have the proper credentials. They specialize in dental implants.

They would not let me post the link.
*edit*

Hi Paulyfred,

You can send me a private message with the email address of the dentist.

FYI... it is not standard protocol to put all dental patients on antibiotics when a tooth is removed unless the patients health is at risk... or the tooth is infected and there is suspicion that the bone is infected as well. In your case based on all that you have written here, I strongly suspect that the tooth was infected and the bone was compromised from the infection. So I do not know why your dentist did not prescribe antibiotics at the time of the extraction. With that said, the antibiotics would have only been useful if all infected tissue and bone were removed at the time of the extraction and there is no telling if your dentist performed that debridement or not.

The problem with waiting is that bacteria can cause the gum tissue to die and if that happens you would require additional surgeries to attempt to replace that tissue. If this were happening to me, I would get the area evaluated asap. If you feel it would be wise to see the periodontist that you are familiar with and get his opinion, then go with that. Have all of your pre and post op xrays sent to him so they are there for your appointment.

Bryanna