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Perforated sinus?

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Unread 11-01-2012, 03:35 AM   #121
spork
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Bryanna,

Good to see you're still around and offering helpful advice. Earlier in this thread you gave me lots of info about an implant I was getting for a tooth that had already had a couple of root canals and a couple of apicoectomies.

I'd like to give you the update if I may...

You may recall that the sinus was perforated when the extraction was done. Unfortunately it was perforated again when he place the implant. But the follow-ups over the next months showed good progress and the torque test on the implant suggested it was good to go for an abutment and crown.

The day I got the crown I noticed that tooth was sensitive to bight on. I assumed this might be normal since I hadn't been able to chew on that side of my mouth for the better part of a year. But after a few days with no improvement I called the doctor that did the implant. He told me the sensitivity was not to be expected. He suggested I come in and let him look at it.

When I saw him, he noted that the tooth/implant was wobbly (and still sensitive - particularly to side pressure). He asked me to come back in two weeks. That takes us to Monday (two days ago). He had hoped it was simply the crown rocking on the abutment. He drilled into the crown and removed the screw so that he could remove the crown. Unfortunately, he confirmed it was the implant that was wobbly - not the crown. He proceeded to remove the implant (leaving me with a sinus perforation for a third time). He then placed a collagen disk in the hole to seal the sinus perforation and promote bone growth. He suspected that the sinus perforation at the time of the original implant placement could be the cause of the bone not grafting to the implant as the soft tissue from the sinus might have grown down into the hole.

So now he has inserted the colllagen disk, ground away some more bone, added some fake bone to promote bone growth, and sutured the gums. I have an appointment to see him again on Monday.

The thing I want to do least of all is repeat this whole process over the next 9 months or so to end up with another failed implant. Is it time for me to give up on teeth all together and live on soft foods for my few remaining years?

Thanks again.
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Unread 11-05-2012, 01:00 PM   #122
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Hi Spork,

Sorry I didn't see your post sooner. I am on the east coast and have been hit hard with the tropical storm Sandy. Just got power back last night after 6 days!! But things are looking brighter for now .. so that is good

I do not recall what tooth you were replacing or if that tooth had been previously root canaled. Could you just update me on that?

If it is in an area that you can live without a tooth, that would be your best bet. When the bone is compromised and/or there is a sinus perforation ... the placement of a dental implant is very risky. Repetitive tries will also be risky and can be compromising to the health of your jawbone and sinuses.

I am surprised that the restorative dentist, the one who put the crown on, did not notice any movement during the placement of the crown. What is the update from your implant dentist today?

Bryanna


Quote:
Originally Posted by spork View Post
Bryanna,

Good to see you're still around and offering helpful advice. Earlier in this thread you gave me lots of info about an implant I was getting for a tooth that had already had a couple of root canals and a couple of apicoectomies.

I'd like to give you the update if I may...

You may recall that the sinus was perforated when the extraction was done. Unfortunately it was perforated again when he place the implant. But the follow-ups over the next months showed good progress and the torque test on the implant suggested it was good to go for an abutment and crown.

The day I got the crown I noticed that tooth was sensitive to bight on. I assumed this might be normal since I hadn't been able to chew on that side of my mouth for the better part of a year. But after a few days with no improvement I called the doctor that did the implant. He told me the sensitivity was not to be expected. He suggested I come in and let him look at it.

When I saw him, he noted that the tooth/implant was wobbly (and still sensitive - particularly to side pressure). He asked me to come back in two weeks. That takes us to Monday (two days ago). He had hoped it was simply the crown rocking on the abutment. He drilled into the crown and removed the screw so that he could remove the crown. Unfortunately, he confirmed it was the implant that was wobbly - not the crown. He proceeded to remove the implant (leaving me with a sinus perforation for a third time). He then placed a collagen disk in the hole to seal the sinus perforation and promote bone growth. He suspected that the sinus perforation at the time of the original implant placement could be the cause of the bone not grafting to the implant as the soft tissue from the sinus might have grown down into the hole.

So now he has inserted the colllagen disk, ground away some more bone, added some fake bone to promote bone growth, and sutured the gums. I have an appointment to see him again on Monday.

The thing I want to do least of all is repeat this whole process over the next 9 months or so to end up with another failed implant. Is it time for me to give up on teeth all together and live on soft foods for my few remaining years?

Thanks again.
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Unread 11-05-2012, 09:59 PM   #123
spork
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Quote:
Originally Posted by Bryanna View Post
Sorry I didn't see your post sooner. I am on the east coast and have been hit hard with the tropical storm Sandy. Just got power back last night after 6 days!! But things are looking brighter for now .. so that is good
No worries. Sorry to hear you got caught in the storm. Glad you came out OK.

Quote:
I do not recall what tooth you were replacing or if that tooth had been previously root canaled. Could you just update me on that?
This is the number 3 tooth. It's had two root canals, two apicoectomies, and we're headed for two dental implants.

Quote:
If it is in an area that you can live without a tooth, that would be your best bet.
Well, it was right there in my mouth with all the other teeth. I had really grown very attached to it. During the 9 months I went without due to the implant I wasn't really able to chew on that side at all. What do people do when they're missing teeth?

Quote:
When the bone is compromised and/or there is a sinus perforation ... the placement of a dental implant is very risky. Repetitive tries will also be risky and can be compromising to the health of your jawbone and sinuses.
That's bad news. He perforated the sinus during the sinus lift, and perforated it again when placing the implant. He seemed to feel there was no cause for concern. When he removed the implant a week ago today it left me with a perforated sinus for a third time. Although actually I don't recall whether removing the implant left me with the sinus perforation or whether that happened when he further prepped the hole for new bone grafting. In any event - I left with one more hole than when I arrived.

Assuming the bone and sinus perforation heals nicely, and a new implant can be placed without causing yet another perforation, do you still give it low odds of success? He gave it a 98% likelihood of success. But then he also told me the sinus perforations were nothing to worry about.

How does an implant typically fail? This one came out with no bone fragments attached to it.

Quote:
I am surprised that the restorative dentist, the one who put the crown on, did not notice any movement during the placement of the crown.
I don't know whether it was loose at that time. But it was certainly sensitive from the first time I tried to chew on it.

Quote:
What is the update from your implant dentist today?
The stitches came loose over the weekend on their own. So I trimmed the loose ends, took pics and emailed them to the implant dentist. I asked if I should just go ahead and remove the one little sliver of suture that remained. He said I should do so if I could do it carefully. So I removed the last tiny suture with a pair of tweezers, sent him another photo, and he told me I could put off the appointment for a week. I'm scheduled to see him next monday.

Thanks again for all your advice.

Rick
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Unread 11-26-2012, 09:40 PM   #124
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Hi Rick

My answers are in BOLD lettering.
This is the number 3 tooth. It's had two root canals, two apicoectomies, and we're headed for two dental implants.

TOOTH #3 IS THE FIRST MOLAR AND IT IS USED FOR CHEWING. HOWEVER, THE HISTORY OF THIS TOOTH AND JAWBONE HAS LEFT THIS AREA OF YOUR MOUTH VERY COMPROMISED DUE TO THE LONG TERM INFECTION, INFLAMMATION AND TRAUMA FROM ALL OF THE INVASIVE DENTAL PROCEDURES. I WOULD NOT MESS WITH THIS BONE ANY FURTHER, IF IT WERE ME.


Well, it was right there in my mouth with all the other teeth. I had really grown very attached to it. During the 9 months I went without due to the implant I wasn't really able to chew on that side at all. What do people do when they're missing teeth?

IN CASES SUCH AS YOURS, THE HEALTHIEST REPLACEMENT OPTION WOULD BE EITHER A 3 UNIT BRIDGE OR A REMOVABLE PARTIAL. I WOULD DISCUSS THOSE OPTIONS WITH YOUR DENTIST IN DETAIL.


That's bad news. He perforated the sinus during the sinus lift, and perforated it again when placing the implant.

THIS INDICATES A LACK OF SOLID BONE WHICH IS NOT A SURPRISE GIVEN THE LONG TERM INFECTIONS AND REPETITIVE DENTAL WORK DONE IN THIS AREA.

He seemed to feel there was no cause for concern. HE WOULD IF IT WERE IN HIS OWN MOUTH!

When he removed the implant a week ago today it left me with a perforated sinus for a third time. Although actually I don't recall whether removing the implant left me with the sinus perforation or whether that happened when he further prepped the hole for new bone grafting. In any event - I left with one more hole than when I arrived.

AGAIN, THIS IS DUE TO THE POOR QUALITY OF BONE. IF THE SINUS CAN REPETITIVELY BE PERFORATED WITH EVERY PROCEDURE .... WHY NOT LOOK FOR A LESS INVASIVE OPTION?

Assuming the bone and sinus perforation heals nicely, and a new implant can be placed without causing yet another perforation, do you still give it low odds of success? He gave it a 98% likelihood of success. But then he also told me the sinus perforations were nothing to worry about.

WITHOUT A DOUBT, THIS AREA OF YOUR MOUTH IS HIGHLY COMPROMISED. FROM A LOOK AT THE OTHER SIDE OF THE DENTAL CHAIR .... I DON'T KNOW OF ONE DENTIST THAT WOULD CONTINUE ON THIS PATH IF IT WERE HIS OWN MOUTH.

How does an implant typically fail? This one came out with no bone fragments attached to it.

IMPLANTS FAIL DUE TO INFECTION AND/OR COMPROMISED BONE. IT CAME OUT EASILY BECAUSE THE BONE IS NOT HEALTHY ENOUGH TO INTEGRATE WITH THE BONE GRAFT MATERIAL OR THE IMPLANT. THEREFORE, THE IMPLANT WAS BASICALLY SITTING IN MUSHY BONE GRAFT AND TISSUE.

I don't know whether it was loose at that time. But it was certainly sensitive from the first time I tried to chew on it.

CHANCES ARE... IT WAS LOOSE AT THE TIME OF THE DELIVERY OF THE CROWN AND YOU WERE NOT INFORMED. I HAVE WITNESSED THIS MANY TIMES AND THE OUTCOME IS ALWAYS THE SAME.... EVENTUAL IMPLANT FAILURE.


Thanks again for all your advice.
YOUR WELCOME. PLEASE DISCUSS OTHER REPLACEMENT OPTIONS WITH YOUR DENTIST.

Bryanna
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Unread 11-26-2012, 09:55 PM   #125
spork
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Once again - thanks for all the good advice - and bad news

I will definitely talk to the oral surgeon about those options - and I very much like the idea of asking what he'd do if it were his mouth.
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Unread 11-27-2012, 09:29 AM   #126
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I have a removeable bridge, just fantastic. No worries about bone loss or grafting, or implants. I didn't want to take a chance, and I was told the truth by the oral surgeon. I came into the dentiest armed with information, and got the truth of my situation. i do wish for you the same good outcome. the bridge is no big deal, looks great, and works just fine. Implants cost a heck of alot more, and the failure rate is high with bone loss and infections. ginnie
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Unread 11-27-2012, 11:42 PM   #127
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Thanks very much for that. I'm not familiar with the concept of a removable bridge. Do they not have to grind down the neighboring teeth to accommodate it? What holds it in?

Thanks.

ETA: a Google search turns this up: http://denturesolutions.org/removable_bridge_work Is this what you're talking about? It looks like it covers all the teeth - not just the missing one and its neighbors. Is that right?

Thanks again.

Last edited by spork; 11-28-2012 at 12:23 AM.
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Unread 11-28-2012, 10:21 AM   #128
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Hi spork, I have something called a besnit, or a nesbit, I get confused at the way it is spelled!!!!! or pronounced!!!!!! Bryanna I know will laugh over this, as I do this every time!!! It holds two teeth, and wraps around the ajoining teeth, no grinding needed on teeth infront or in back. This is comfortable, and not that expensive to do. I think having one depends on what teeth are missing. I didn't even know about them until my dentist recommened this to me. Better than bone grafts and inplants where I can't afford that anyway. Hope you will look into it. Sorry for my confusion!!! That is why I didn't test well in school. I knew the answer, what it meant, just couldn't spell right! ginnie
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Unread 11-28-2012, 10:22 AM   #129
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You will laugh at my post to Spork, I did it again!!!! This woman gets so confused!!!! ginnie
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Unread 11-28-2012, 12:41 PM   #130
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Thanks very much Ginnie. I will very definitely look into it. I have an appt for a consultation with a local oral surgeon on Monday, and I want to discuss all options with him.

ETA: Just found this http://en.allexperts.com/q/Dentistry...uestion-12.htm Looks like you got it right to me.
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