A Dental Implant Case

Today I had the opportunity to explain to a new patient about the proper treatment protocol for a tooth that she is losing.  Here is a great lesson about what to do when you are about to lose a tooth. The patient was told by her previous dentist:  "Your tooth has a infection.  Let's put you on antibiotic.  Then...you come back for us to extract the tooth and to do some bone graft.  Then...TWO WEEKS LATER ... we can prep the adjacent teeth for a bridge to replace that same missing tooth."

I have never heard of any bone grafting material that can fully stabilize an extraction site in TWO WEEKS.  A typical bone grafting site requires any where from 4 to 6 months of healing time.

In addition, the tooth behind this failing tooth is also compromised.  Using it to anchor a bridge also will not provide the patient a predictable long term result.

In a case like this where an active infection is present due to a failed root canal treatment with compromised root structure we must be even more careful with our treatment plan.  A Gum Specialist (periodontist) or an Oral Surgeon would be best to handle the surgical aspect of this tooth.   The proper treatment sequence would follow something like this:

1.  Antibiotic Regiment to suppress the infection

2.  Extraction of the failed tooth with proper bone grafting done at the same time

3.  Wait for proper healing.  Typically 4-6 months

4.  Placement of the dental implant to replace the missing root

5.  Wait for proper healing.  Typically another 4-6 months.

6.  Placement of a new crown on top of the dental implant.

As a patient, you need to be educated enough about a complex procedure before agreeing to the recommended treatment.  Dental Implant treatments require proper coordination between a surgeon and a restorative dentist in order to achieve a successful outcome.  This patient had made a very wise decision to seek multiple consultations with different dentists before choosing her own treatment choice.

Let's take a look at the tooth:

√  The furthest left arrow points to the compromised root which was proposed to be the anchor for a new bridge.

√ The middle arrow points to the fractured root of the tooth in question.

√ The right arrow points to the infection and bone loss around the infection.



Alex Nguyen, DDS is a Saratoga Dentist who practices General Dentistry, Cosmetic, and Implant Dentistry. For over 20 years the practice has been serving the residents of Santa Clara County and San Francisco Bay Area.