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Infections and Dental Implants
Lucy, a dental implant patient asks us:
I am a patient and was given two different opinions about treatment. I am having my molar extracted, tooth grafted and a dental implant placed.
There is an infection in the area. The first opinion I received was of having the dental implant done immediately, as the dentist goes in, does the extraction and grafts. The second opinion was to do the extraction, graft and then wait for the infection to heal before putting the dental implant in. What do you suggest is the best way? Should I wait for the area to heal, or should the dental implant be done right away and why? What are the pros and cons? What is the success rate in each case? Is there statistical data to support this?
February 24, 2006 in Treatment Planning & Complications | Permalink
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Comments
After 14 years of placing implants, I would tell you that both options are valid. For me, the difference depends upon the ability to get stabilization of the implant which can be more difficult in immediate extraction cases esp. in a molar region because of the size of the remaining socket and likely additional bone loss due the infection(you mentioned that grafting is necessary. The presence of an infection is usually not the issue as the infection is comming from the tooth which will be removed and the site should be completely dedribed. Three important words: stability, stability and stability of the implant. Cost and healing times will likey be close or the same. In my own practice, for molar sites, I generally prefer to extract the tooth, graft the area, wait 3-4 months then place the implant (in solid bone, read as stability) as a single stage procedure.
Posted by: Dr. M. | Feb 26, 2006 2:12:29 PM
There is an oral irrigant, exxcl oral blue, that has been shown to be an effective bactericidal solution for the treatment of infections and biofilm infestations, especially around the extraction sockets. During the placement of both bone grafts and implants, flushing the area with exxcl oral blue will enhance the healing and provide a barrier to any new biofilm formation.You can contact us at www.exxcloralblue.com for more information. This new website should be up and running by March 6, 2006
Posted by: | Feb 28, 2006 2:58:19 PM
My experience with root form implants tells me it is ok to place the implant as long as one can remove all the granulomatous tissue /cyst and get two things: bleeding as you need the cells from the marrow and secondly if you attain a stabilization of the fixture
Dr EGC
Posted by: | Feb 28, 2006 3:02:32 PM
In an ideal world , the tooth would be removed the site grafted and left alone for EIGHT months. Then the implant would be placed and depending on whether it's in the upper or lower arch you'd have to wait another 4 to 6 months before you could get a tooth there.Whew
I routinely immediately place and many times immediatedly load the same implants. There are many advantages to immediate placement
A.shorter treatment time
B.less surgical visits
C.heal once and for all.
Disadvantages:
A.If the case fails, return to square one with less bone than you originally had, more complex bone grafting procedures may even be necessary.You have to undrstand what you're getting into from the get go.As you may begin to realize both treatment options are viable.We've reached a point in implant dentistry where alot of fabulous treatment options are working beautifully and the benefits are as mentioned above.You can go for it, but if you do understand that if it doesn't work out you know what has to be done to make it right(with more time,effort and expense)
Posted by: Dr. R Mosery | Feb 28, 2006 4:34:10 PM
I'm surprised nobody has mentioned delayed placement which cuts the treatment time by 12-14 weeks. The tooth is removed, the site is let heal for 3-4 weeks and the implant can be placed if sufficient bone is available for stability as was well stated by Dr M
Posted by: | Feb 28, 2006 5:41:37 PM
If you want to be safe, especially in an infected molar region, the ONLY way to proceed is to extract the tooth, wait 4 to 8 weeks for the soft tissue to heal over the site and allow the body to completely eliminate the infection, and then proceed with the graft and implant. As far as placing the implant at the same time as the graft, that depends solely on the ability to achieve primary stabilization of the implant in the available natural bone. Of course there is the debate over one large implant or two smaller ones (My thought is simple, there are always two roots, right?). In a molar area, especially with an infected and placing a graft, the chief concern is the ability to close the space without pulling the incision too much. That is why, if you are going to invest a couple of thousand dollars in the procedure, it is worth waiting a few extra weeks in the beginning to allow the doctor to work in a healthy area. Good luck.
Posted by: FJD | Feb 28, 2006 6:54:29 PM
Wait until the infection has resolved. When the tooth is removed an evaluation of the bone can be done and a better idea of what can be accomplished immediately can be made. Graft or immdediate placement with graft. I tend to go conservative it works better.
Posted by: Dr MM | Mar 1, 2006 7:33:04 AM
Thank you so much for all of your help. A question was also raised in regard to grafting. What is the safest way - should that be done at the time of the extraction, or should there be time alloted between the extraction and the graft? What is better and what are the pros and cons?
Posted by: Lucy | Mar 1, 2006 11:12:19 AM
Dear Lucy,
There are so many variables in dentistry because the human body is capable of healing, even after what can sound really invasive.
My personal advice would be to have the tooth removed first, and graft at the same time. Let the area heal for about 12 weeks. This allows the gum to heal over and the infection to heal. When infection is in a site that an implant is to be placed, a slightly higher risk of failure to osseointegration. Additionally, infection means there is less bone (depending upon the size of infection. Waiting a little, for something that will last many years is definitely worth it. The final point I will make is that, again in my experience, it is hard to predict exactely how the gum will heal after an extraction. This can be better predicted if healing of the gum occurs first. Then when the implant is placed, some variables are out of the equation.
A second issue that you have is the grafting. I am guessing that you are having a bone graft and not a gum graft. Bone grafts are probably best done at the time of extraction. The main advantage of this is that it eliminates an addition surgery time for you. Also, when the extraction is done, most of the time the dentist/surgeon is able to see where the bone is deficient, and can graft accordingly. Most specialists that I know (i am a general dentist) prefer to wait at least 8 months after grafting before placing an implant.
As one of the respondents mentioned, it is possible to extract, place the implant and then graft around it. It really depends upon the amount of infection, the amount of bone that needs to be grafted and where the tooth is.
To conclude, I would definitely not recommend extraction, a separate surgery to graft, and then an additional surgery to place the implant. Combining procedures is less invasive to you, and often a better result is possible.
I hope this helps!?! Good luck.
Posted by: Dr. G.D. | Mar 1, 2006 9:53:36 PM
Hi Lucy:
From my 11 years experience in dental implants. I suggest not to put a graft in infected site. Because this will not hold,At least to wait for 3-4 weeks until healing started and infection resolved. Good Luck
Posted by: DR.Tarek | Mar 1, 2006 11:36:16 PM
Dear Lucy the more you learn the more confused you will become as you see there are many alternatives and most work well.Just trust your surgeon an dhis experience and all will be well,Good luck
Posted by: Peter Fairbairn | Mar 4, 2006 3:01:10 AM
I am a patient and I had dental implants done on my front upper tooth. It was implanted immediately after extraction and I had no infection in the tooth before the implants (the tooth broke and had to be extracted)
Three weeks later, there was an infection and the surgeon removed the implant and he said we would have to wait two months to implant again after gum heals.
What could I have done to prevent this? I am very healthy and took extreme after the procedure but still got the infection. Any advice?
3 weeks later, there was an infection and the implant had to be removed and now I have to start all over.
Posted by: | Mar 7, 2006 8:11:34 PM
The more you research, the more you will get confused. There are many ways to do the same thing. My 2 cents say if there is puss, no graft and no implant. Clinical situation will dictate the protocol use.
Posted by: Brad | Mar 13, 2006 9:35:26 AM
infection in tooth bone area means periapical pathology granulation tissues and infected cells, no body will be sure if the site will be clean after extraction,also healing depend on mainy factors,presence of infected cells may delay healing interfere with graft attachement also with ossio integration,the worse will be acute infection,every thing will be lost (graft+implant) the protocol of grafting and or implant is as follw :1 -extraction, clean the area let it heal for tow months 2- evaluate the amount of graft needed if it horizontal or vertical ,if the area needs graft badly graft should be done as a separet step 3-implant placement as a final step. this treatment plan looks longer time wise but it is safer eliminate the risk of infection,and failire of bone graft and or implant ossio- intigration . from DR.M.ALI, DDS.MS.
Posted by: DR.M.ALI DDS,MS. | Mar 26, 2006 7:27:39 PM
I have a bad history of sinus infections. I heard that some dentist will not do implants for this reason. Should I be concerned. Also, the reason for my teeth extraction is I have Periodontal Disease. My dentist has told me he will have to rebuild the bone and I will have a denture for at least a year before implants can be done. All this work is being done on my uppers. Thats the reason for the sinus concerns. I am hearing so many different things and I have no idea what I'm going to do.
Posted by: rhonda | Apr 13, 2006 5:41:33 AM
I am doing as much research on dental implants as I can, but am unsure how I should proceed. I just had two teeth (#5 and #12) extracted. My dentist and two oral surgeons to whom I spoke highly recommend waiting 8 weeks to have the implants placed. I went to a third oral surgeon (simply because he had weekend hours). He told me that, had I come in for a consultation, he would have been able to do the implants immediately after extraction. I now have an appointment for the end of May (4 weeks from now). Is this long enough to wait? Does waiting eight weeks instead of four really increade the odds of success?
Please understand that there is no infection or other dental problems present.
Posted by: Stephanie | Apr 23, 2006 6:43:56 AM
I just had a second dental implant done a couple days ago. both because of botched root canals. The first one was done a few yrs ago about 6 months after the tooth was pulled, no bone graft. This one was done immediatly following the tooth extraction with a bone graft. I remember a little bit about the pain of the extraction but I do believe that this time around there is just a bit more pain. jaw swollen more than last time. Dentist just prescribed a 3 day steroid for the swelling. If all goes well it will be worth it and save 6 months of time to get my new tooth in place.
Posted by: Cheryl | Jun 23, 2006 3:26:55 PM
I had a dental implant done one year ago on a front tooth every thing looked good, they were concerned the bone wouldn't hold but i guess it did, today a year later I realized if you look at my gum above the implant you can see the actual screw.
I went back to the dentist who secured the implant, who said i need to see a gum specialist, but he's afraid I'm allergic to the titanium, also I have an open sore right at the top of the tooth where it meets the gum. It's not painful, yet but I keep hearing I can not be allergic. Why not the gum is gray/black at the site the rest of my gums are pink.
Posted by: Jjeanne | Jul 14, 2006 1:19:53 PM
There is no data on the sucess of bone grafting into an infected extraction site. General surgical principle indicates that a graft (bone or implant) be placed into an infected site.
Posted by: TW | Jul 15, 2006 4:40:33 PM
I am sorry for leaving out the "not" in my prior post.
-There is no data on the sucess of bone grafting into an infected extraction site. General surgical principle indicates that a graft (bone or implant) NOT be placed into an infected site.
Posted by: | Jul 15, 2006 4:41:53 PM
I had 2 dental implants next to eachother done 2 weeks ago in the lower left molars. One of them is healing fine, the other is swelling like a bubble which I'm assuming is an infection. I am still taking pain medication for the constant throbbing every 4-6 hours. I am concerned that something could be seriously wrong. Should I be concerned or is there something I should be taking (antibiotics) to help the healing? Or could this be one of the signs that I am rejecting one of the implants? Not sure how long I should go with this before I return to the dentist.
Posted by: Diana | Sep 21, 2006 3:10:39 AM
Diana; please contact your dentist regarding this pain and if this dentist does not seem to care please ask him to refer you to a dr who does. You should not be suffering after 2 weeks from an implant.
Posted by: | Sep 21, 2006 7:07:59 AM
I had an implant done on lower molar right side 6 years ago. Every thing was apparently fine until a year ago when my Dentist said I had a pocket beneath the tooth. He told me to floss more and use a water pick. Then in August 06 he told me to go see a Periodontist. Diagnosis 80% bone loss. What happened ?
Posted by: | Oct 24, 2006 5:15:34 PM
I had dental implants just over two years ago. Apart from one tooth coming loose after a few months and then being tightened I have experienced no problems.
However, every so often, I'd say twice a year I get discomfort in the area where one of the implants are,from the same tooth that became loose initially. The area is often a bit swollen and I bleed there after brushing. Then I use an antibacterial mouthwash (oraldene) until it clears up. This usually clears up after a few days and everything is fine.
Do you think this problem is down to bad hygiene on my part or do you think I should see the dentist that did the implant. I'm thinking if it was something serious then it would take more than a mouthwash to sort out?
I hate dentists and I am fearing more xrays.
Posted by: B Carr | Dec 28, 2006 9:55:02 AM
I am going through a dental nightmare at the moment. Having become more meticulous in observing details with all of my teeth, I noticed yesterday that in the very back of my lower jaw where I had a wisdom tooth removed ages ago, there is a tiny spot where I can feel bone. It's as if my gums never completely closed over that spot.
I have taken osteofos (generic fosamax) on and off for the last three years. Before that I took Evista regularily for osteopina. I'm having little freak out at the moment because of what I've been reading about ONJ. I'm 42. Is this a sign of ONJ or could it be something else?
Posted by: | Apr 8, 2007 5:23:05 AM
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