Dr. W. asks:
What is the consensus on sinus grafting at the time of extraction of an infected tooth, such as with a failed root canal treatment? Is there a greater chance for success in a situation like this if I extract the tooth with failed root canal treatment and allow the area to heal first and then go back in later in a separate surgical procedure and do the sinus lift and bone graft then? I know some dentists extract a tooth with an active infection and graft or place implants at the time of extraction. Any recommendations?
Consenus on Sinus Grafting at Time of Extraction with an Infected Tooth?
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No Problem with the Bacterio static graft materials but beware of Xenografts.
My recommendation is dont do it. Why take the chance, take out the tooth, clean out the infection and graft the socket. Your already asking for alot. Why introduce another problem by trying to graft the sinus. If the graft fails all you are cleaning out is the socket.
If you do a sinus lift and now the sinus gets infected you have a bigger problem on your hands. Why push the envelope when delayed approach is more predictable.
GOOD DAY, MY OPINION IS THAT IF YOU CAN EVALUATE THE BONE GRAFT AS LONG AS THIS INFECTION CONTROLLED DRUGS UNDER PRIOR TO SURGERY FOR SPECIFIC TIMES TO EVALUATE THE AREA BECAUSE THIS DEAL? DRUG USE BY PROPRIETARY, EVAUAR THE POSSIBILITY OF A SIMPLE OUTLINE OF ANTIBIOTICS OR COMPLEX OR TRIPLE, EVALUATE THE AREA OF THE MAXILLARY SINUS BY A POSSIBLE SPREAD OF ABSCESS, because as I mentioned DR. JOE BROGAN IS NOT WELL TESTED will now have more problems now with not only a dental organ but also with a maxillary sinus, well worth a SERIOUS SECOND SURGERY FOR BONE REGENERATION Since infections with bacteria mixed aerobic and anaerobic SOMETIMES often very difficult treatment, as the famous phrase DR. ROBERT MARX “AS YOUR KNOWLEDGE OF PATHOLOGY, WILL YOUR BUSINESS QUALITY OF LIFE. REVISE THE USE OF plasm rich in grown factors. THANKS
An excellent review of ‘The bacterial flora of the Normal Maxillary Sunus” by Itzhak Brook (national Naval Medical Center, Bethesda)has been reiterated by Topazina & Goldberg (Oral & Maxilofacial Infections), and several others.
All of them by and large re-iterate that a “normal” maxillary sinus is a potential storehouse of both Obligatory and Facultative Anaerobes and several Beta lactamase producing Gram positive microbes as well.
That the quality of wound healing in any area is affected significantly by the presence of interferences such as presence of contamination, infection, asepsis etc, is well known lore.
That being the case, prudence would dictate that in the presence of ‘active’ infection, it would be advisable to allow for healing to precede (in the extraction socket area) prior to involving the area with a graft material for the purpose of augmentation.
The use of Allografts and Xenografts would obviously increase the potential as the nidus for the growth of the microflora and offensive pathogens is overwhelmingly attractive to the propagation of full-fledged infection within the graft area.
More often than not, will require a Caldwell-luc approach (even if it was an Indirect Sinus Lift that was carried out after the extraction) to clean out the Schniedarian membrane along with the graft material.
The role of Calcium admixed graft substitutes such as Beta-TCP et al, whilst proven to be bacteriostatic in some measure, would not prove to be “effective’ against an actively smouldering Sinus infection.
I agree with Bargo! Do this as a staged procedure ie ext. curette pathology then graft the socket and let things settle down. You can graft the sinus later after you can verify absence of sinus pathology and osteomedial patentcy. Believe me it doesnt take much to mess up a sinus and even if your OS and Perio buddies graft in the presence of path and infected teeth, it wont be worth your risk!!
Practice defensive medicine/dentistry. What would you have to gain by doing the procedure of sinus grafting at the same time of extracting a tooth with periapical pathology..pushing the envelope too far may give an upset patient cause to seek legal counsel.
Would the procedure be handled the same way by another practitioner?…or would they present that a prudent practitioner would have done it in a staged treatment due to the underlying infection of the tooth/periodontium at the time of extraction?
We are in a litigious society.