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Has my Bone Graft Failed Again?

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Unread 02-21-2011, 01:36 PM   #1
mousch
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Confused Has my Bone Graft Failed Again?

Hi to everyone here. I've found the listed questions and responses in this forum very helpful in my experiences with bone grafts the past 4 months. I'm already very thankful to the previous posters who have helped calm my nerves.

In October I had tooth #19 (first molar on left side?) removed and a bone graft inserted in preparation for an implant. There was a massive chronic infection beneath it which had deteriorated much of the bone. A few weeks after the procedure, a large amount of the bone graft material was spit out while I was rinsing my mouth. The graft was considered a failure and I was referred to a periodontist.

Ten days ago the periodontist attempted another bone graft. The x-rays showed that a lot of the graft material had stayed in and grown, so the previous graft was partially successful.

He knew about my previous failed bone graft and so did a gum transplant to help close the site. It seemed to be going well, but a few days ago white material sort of stuck up from the site in a little sheet. I could see two of these 'sheets' but they seemed fairly stable, so I decided to just ignore them and do my thing. Today while rinsing my mouth both of these sheets of material came off. I did rescue one from the sink and took a photo of it, but this is my first post so I can't provide a link...


Both pieces of material were roughly the same size. I was not brushing the graft site with my toothbrush, and was following my aftercare instructions. I do not smoke.

I see my dentist on Thursday for a followup. I am just anxious that once again I will hear that the graft has failed and have to go for a third procedure.. meaning more pain, anxiety and money. This is all very frustrating, and I was already quite unhappy that I had to pay for one failed graft procedure.

Any idea what could have happened here? The first dentist didn't tell me that such a large graft was likely to fail until after it had already failed. It has been afrustrating process.
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Unread 02-22-2011, 10:02 AM   #2
mousch
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While brushing my teeth this morning, more material came out and the site looks caved in. I am pretty sure that it has failed.
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Unread 02-28-2011, 07:48 PM   #3
Bryanna
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Hi mousch,

First of all, bone graft material will not integrate in an area of jaw bone that is infected. That is one reason why your grafts have failed. In a case such as yours, before a bone graft procedure can be done....... the tooth needs to be removed and the bone needs to be debrided, antibiotics are given and the surgical site is left alone for several weeks to months depending on the degree of infection. The surgical site is monitored with periodic xrays to determine when the infection is gone. Once that is determined, then the area is surgically exposed and a bone graft is placed.

Anytime a bone graft is placed in the jawbone before the infection is gone, the area will become overwhelmed with bacteria and the graft will fall out. Irrelevant of what is used to cover the surgical site, the graft will fail. It sounds like that may be what's happening to you.

Sorry I didn't get to post this earlier.... what did the dentist say at your appt on thursday?

Bryanna






Quote:
Originally Posted by mousch View Post
Hi to everyone here. I've found the listed questions and responses in this forum very helpful in my experiences with bone grafts the past 4 months. I'm already very thankful to the previous posters who have helped calm my nerves.

In October I had tooth #19 (first molar on left side?) removed and a bone graft inserted in preparation for an implant. There was a massive chronic infection beneath it which had deteriorated much of the bone. A few weeks after the procedure, a large amount of the bone graft material was spit out while I was rinsing my mouth. The graft was considered a failure and I was referred to a periodontist.

Ten days ago the periodontist attempted another bone graft. The x-rays showed that a lot of the graft material had stayed in and grown, so the previous graft was partially successful.

He knew about my previous failed bone graft and so did a gum transplant to help close the site. It seemed to be going well, but a few days ago white material sort of stuck up from the site in a little sheet. I could see two of these 'sheets' but they seemed fairly stable, so I decided to just ignore them and do my thing. Today while rinsing my mouth both of these sheets of material came off. I did rescue one from the sink and took a photo of it, but this is my first post so I can't provide a link...


Both pieces of material were roughly the same size. I was not brushing the graft site with my toothbrush, and was following my aftercare instructions. I do not smoke.

I see my dentist on Thursday for a followup. I am just anxious that once again I will hear that the graft has failed and have to go for a third procedure.. meaning more pain, anxiety and money. This is all very frustrating, and I was already quite unhappy that I had to pay for one failed graft procedure.

Any idea what could have happened here? The first dentist didn't tell me that such a large graft was likely to fail until after it had already failed. It has been afrustrating process.
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Unread 04-13-2012, 12:36 PM   #4
John Steven
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Hi Bryanna,
I am a new member,so please excuse (and don't hesitate to educate) any error in protocol. This post has helped me very much. Thank you. I entered a post yesterday about my dental situation. Can you respond to it? I don't know how to direct you to it, except to say my user name is John Steven and yesterday's is my first and only post, excepting this reply.
Thank you,
John Steven

Quote:
Originally Posted by Bryanna View Post
Hi mousch,

First of all, bone graft material will not integrate in an area of jaw bone that is infected. That is one reason why your grafts have failed. In a case such as yours, before a bone graft procedure can be done....... the tooth needs to be removed and the bone needs to be debrided, antibiotics are given and the surgical site is left alone for several weeks to months depending on the degree of infection. The surgical site is monitored with periodic xrays to determine when the infection is gone. Once that is determined, then the area is surgically exposed and a bone graft is placed.

Anytime a bone graft is placed in the jawbone before the infection is gone, the area will become overwhelmed with bacteria and the graft will fall out. Irrelevant of what is used to cover the surgical site, the graft will fail. It sounds like that may be what's happening to you.

Sorry I didn't get to post this earlier.... what did the dentist say at your appt on thursday?

Bryanna
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Unread 04-13-2012, 06:04 PM   #5
Bryanna
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Hi John,

I found your post about your dental problems and will try to copy and paste it on this forum. Not sure I can do it or not. If not, then I will reply to you on the other forum.

Bryanna

Quote:
Originally Posted by John Steven View Post
Hi Bryanna,
I am a new member,so please excuse (and don't hesitate to educate) any error in protocol. This post has helped me very much. Thank you. I entered a post yesterday about my dental situation. Can you respond to it? I don't know how to direct you to it, except to say my user name is John Steven and yesterday's is my first and only post, excepting this reply.
Thank you,
John Steven
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Unread 04-13-2012, 06:08 PM   #6
Bryanna
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Default Post written by John Steven.....

Re: Root canal tooth extraction and bone grafting....

My #8 and #10 teeth were root canaled 40 years ago, and have been supporting a 3 tooth bridge (#9 was completely knocked out) ever since.
#8 and #10 is abscessed and needs removal. #9 socket has a cyst.

Oral surgeon wants to remove 8 and 10 and at same time place autologous bone grafts there in preparation for implants. I'm not sure I want implants but don't want to rule them out. What's the record on this type of procedure? It sounds aggressive to me. But the oral surgeon says if I don't have the grafting done at time of removal, it is impossible to grow bone later. Is this true?

#9 is a cavitation. Holistic dentist will remove. Oral surgeon says he will too, but it wasn't part of his quotation!

What is the record on infection and failure of both titanium and zirconia implants? My holistic dentist recommends just using a partial, and possible later a bridge supported by #6 and #11.

I am very grateful for this forum.
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Unread 04-13-2012, 07:41 PM   #7
Bryanna
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Hi John,

Not sure I'm allowed to re-post your post here...... but I wanted you to be able to find it. So if I get a slap on the hand.... I'm sorry moderators but I'll take it :/

Okay...here's my reply.
Your situation is not uncommon. People loose their front teeth for various reasons most often due to some sort of trauma. The conventional standard of care treatment plan is to root canal the teeth that are said to be "salvageable", which is what you had done many years ago. However, since #9 was completely evulsed during the incident, it is likely that some portion of the roots of both #8 and #10 (perhaps even the jawbone) were at minimum fractured at that time. So at some point these "salvagable" root canaled teeth were going to show signs of infection and need to be removed. Just to clarify in case you were not previously informed ... #8 and 10 did not just become infected after 40 years....they were definitely in jeopardy at the time of the incident.

When there is an accident involving the front teeth.... treatment options should be discussed prior to any dental work being done. Some of the options may seem radical like removing the teeth rather than root canaling them... but all options should be discussed first. The common problem with the type of treatment that you had done is that by the time the symptoms of infection are evident and/or the dentist suggests to remove the teeth, the surrounding bone supporting the teeth is not very healthy which makes replacing the teeth a bit complicated.

You stated that tooth #9 has a cavitation. This condition can occur for several reasons, some of them are...... a long standing (initial low grade) infection resulting from an infected (frequently root canaled) or abscessed tooth and/or a long standing infection from trauma and/or a surgery that did not remove all of the diseased tooth and/or tissue. Inflammation sets in, the bone breaks down and the blood vessels can no longer supply blood to that area. Three major concerns with this condition are.... #1) it can be complicated to treat and eradicate completely so that site may not be a healthy place to put an implant ... #2) the bacteria can spread from one area of the bone to another which means the bone on either side of the cavitation may not be healthy sites to place implants ... #3) it can become (or contribute to) a systemic health concern if the bacteria travels to another location outside of the mouth so a cavitation should be taken seriously and treated properly.

To answer your questions...
Placing bone grafts in the area of #8 and 10 should only be done if the bone is healthy in those areas. If it's not healthy, then the grafts can become infected and this compromises the bone even further. It is true that without the grafts you will not grow adequate bone on your own to hold implants. The oral surgeons that I know recommend the placement of the implants no later than 6-9 months after the grafting because the bone will break down if there is nothing for it to support. An alternative to placing bone grafts immediately would be to remove the teeth, thoroughly debride the bone removing all disease tissue, then leave the sites to heal for several weeks. Then a second surgery can be done to place the graft material. A few months later, a third surgery can be done to place the implants. Several months after that, the crowns can be done. You would be wearing a partial denture during the healing phase of the three surgeries. The surgical areas are monitored a few times with xrays to see the progression of the healing and integration of the grafts. But it is important to keep in mind that even with all of this surgery, all of these sites are considered compromised due to the initial trauma, the long standing infection from the root canal therapy and the cavitation on neighboring missing tooth #9.

By the way.... I am in favor of Biological dentistry which embraces various forms of holistic dental treatment. My question is... if you are seeing a holistic dentist for the cavitation surgery on #9, why isn't he the one removing #8 and 10 ? What does he say about adding bone graft to all three of these areas? What does your oral surgeon say about the cavitation with #9?

The record on failure and/or infection with either zirconium or titanium dental implants consists of many factors. The biggest concern stems from the placement of either one of them in unhealthy bone and for all of the reasons I mentioned earlier. Which it sounds like your holistic dentist is concerned about and thus recommends the partial denture and possible bridge later on from 6-11. Both types of material are considered bio-compatible which means the majority of the population will not reject either material due to incompatible sensitivities. One material might be favored over another depending on the individual circumstances and the preference of the surgeon.

I hope this information is helpful to you.... please come back with some feedback and any other questions or concerns you might have.

Bryanna






Quote:
Originally Posted by Bryanna View Post
Re: Root canal tooth extraction and bone grafting....

My #8 and #10 teeth were root canaled 40 years ago, and have been supporting a 3 tooth bridge (#9 was completely knocked out) ever since.
#8 and #10 is abscessed and needs removal. #9 socket has a cyst.

Oral surgeon wants to remove 8 and 10 and at same time place autologous bone grafts there in preparation for implants. I'm not sure I want implants but don't want to rule them out. What's the record on this type of procedure? It sounds aggressive to me. But the oral surgeon says if I don't have the grafting done at time of removal, it is impossible to grow bone later. Is this true?

#9 is a cavitation. Holistic dentist will remove. Oral surgeon says he will too, but it wasn't part of his quotation!

What is the record on infection and failure of both titanium and zirconia implants? My holistic dentist recommends just using a partial, and possible later a bridge supported by #6 and #11.

I am very grateful for this forum.
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