Hi Jenni Elle,
The second surgeon is correct... the only way to cure the problem is to remove this tooth and the sooner the better.
Number one, the root canal never cured the original infection. #2 The infection spread to the jawbone. #3 The apicoectomy cannot cure the infection inside of the tooth and only added insult to injury causing more inflammation. #4 The bone graft is being rejected by your immune system because the bone is infected and the body wants to get rid of it. #5 In addition to the infection and bone graft rejection, the tooth is probably fractured, which is typical for root canaled teeth. It is important to know that only in certain circumstances can a pressure test detect a fracture.
Your oral surgeon (the second one) took the no nonsense attitude with you because he knows there is no hope for this tooth and that your dentist will most likely not admit that to you.
I have seen this scenario countless times.... the best option is to remove the tooth and the infected graft material. Let it heal for several weeks and go back in to attempt another bone graft. Then wait 6 or so months before the implant is put in. If you try to hang onto this tooth, irrelevant of the treatment done to it or the bone, the infection will spread and replacement with an implant in the future will be very risky or impossible.
I know this is not what you want to hear... but because this can be a serious health risk it is important to know that the infection can spread to your sinuses and beyond and that your brain is only 3-4 inches from the root of the tooth.
I urge you to think twice about what the second oral surgeon advised you to do. He's right on.
Originally Posted by Jenni Elle
I had a maxillofacial cyst removed from my upper left jaw above a root canaled tooth about 3 months back. The oral surgeon performing the procedure filled the area with a bone grafting and I was sent on my way for recovery.
About a month after the procedure, I returned to the oral surgeon as there was a growth on the side of my gums directly outside of where the surgery to remove the maxillofacial cyst was performed. The oral surgeon advised that a few lose pieces of the bone grafting most likely broke free and were trying to push their way out. She put me on 7 days of antibiotics if there was any infection and then went in for a second procedure to remove the pieces of bone grafting that had pushed out, cleaned the area up, and stitched everything back together.
It is now a month and a half later and I'm having the same issue. There is a very large growth on the outside of my gum area.
I chose to go to another oral surgeon for a second opinion; he didn't do x-rays or anything other than look at the x-rays and a CT Scan from before the cyst removal took place. This surgeon told me my only option is to remove the tooth and have an implant put it as there must be a fracture to the root of the tooth. I asked if there was any way to confirm a fracture and was told no. I then advised that prior to the removal of the maxillofacial cyst there had never been a growth on the outside and it had already had issues once with small pieces of the bone grafting being pushed out. An apicoectomy was performed on the tooth during the surgery. I then presented the idea to him that perhaps the bone graft was rejecting fully. He pretty much brushed my concern under the rug and stated my only option was removal of the tooth, another bone graft, and an implant.
I didn't trust this second opinion and thought that my only option being removal and implant was a bit extreme so I contacted my dentist, whom I trust greatly, and made an appointment to see him that afternoon. He did, in fact, have multiple pressure type tests that he performed that ruled out a fractured root. During x-rays performed, he pointed out the root canaled tooth and advised if there was a fracture, the entire surrounding area would have a black line and none was present. There would also be sensitivity in the tooth, gums, and surrounding teeth; again, none was present. He then did an x-ray higher up at an angle to see the area in which the cyst was removed. He pointed out the exact area of the bone graft, including a distinct line surrounding the bone grafting to show that it wasn't, in fact, integrating with the bone in my jaw. He has contacted the original oral surgeon to advise that there is a bone integration failure and that my jaw is rejecting the bone grafting and it needs to be removed.
I'm terrified to have this procedure done again. I'm going for a consult with my original oral surgeon on Tuesday and the woman I spoke with in the office havsadvised that she has never heard of a bone graft failing with a maxillofacial cyst. She has however had it happen with dental implants.
My dentist has already advised that I need to have the bone grafting removed. I asked the woman at my oral surgeon's office what they would do after the removal. If they would fill it with another type of bone grafting or if they would leave it empty and just stitch up the area and let it grow in naturally. I don't know which option is worse, chancing another bone graft rejecting and having to have the surgery a 4th time or chancing an infection without a bone graft.
I don't even know where to go from here and the office staff can't advise me what the normal procedure for something like this is as they haven't encountered it before.