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Can this implant be saved?

Last Updated: Sep 18, 2013

Please see the x-ray below.

16 days ago I had an implant placed (several months after extraction and bone grafting) on the right upper side of my mouth and an extraction/bone grafting on the right by an OMS. The extraction healed as expected, but I began having very significant pain over the implant site. Five days later, I was in serious pain and called the dentist (I was out of town on business); he prescribed zithromax (I am allergic to Penicillin/Sulpha) as I wasn’t going to be back in town for two more days. I saw him a week after the implant, and he said the implant was fine, I just had a canker sore,unrelated to the procedure or the implant. He took no x-rays. Having no experience with canker sores (and there was definitely some sort of significant swelling on the gum well above the implant sites), I took him to his word, and waited for improvement. I had a follow up appointment 14 days post implant, still in very significant pain. He tapped on the implant, said it sounded “solid” and it didn’t hurt when he tapped. He indicated still a canker sore and it would go away.

The following day (yesterday), in serious pain, I called the office to ask for an email of the x-rays; I was thinking of a second opinion but didn’t say so. The OMS called me back; I indicated that I had pretty serious pain and that if I tapped the implant it hurt. I went back to the office. He tapped it again, said it sounded “hollow”, different then yesterday and it was very painful when he tapped (though I don’t believe my head actually hit the ceiling, it was close). He said it was now clearly infected, put me on another z-pak. He did not take an x-ray. I took the loading does of zithromax yesterday. This morning my gum around the implant is quite swollen (I can’t feel the end of the implant with my tongue.

Obviously there is an issue here. My questions:
Is the implant at risk; if so how much? Is a second course of zithromax appropriate, since the first one didn’t seem to do it Is this dentist on the right track, following this appropriately? Should follow up x rays shoud have been taken? Should I get a second opinion (beyond this virual one)?

Any input is greatly appreciated. As you can tell from my xray below, I have had ALOT of dental work, and this is the first signficant complication/post-work pain I have had, and I am definitely not enjoying it! Best, AJ

8 Comments on Can this implant be saved?

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Dr Jerome BHUNJUN

9/19/2013

From the X-ray . Provisional diagnosis: Peri-implantitis but AROUND the healing screw. I would have removed the screw and allowed the implant to stay submerged after healing and closure of the gingiva( maybe a bit of curetage and floshing of the wound.

Dr. Nitin Deora

9/19/2013

i would like to see the clinical picture of the site and an IOPA (RVG) of the implant before commenting on it. kindly post these 2, u can also email them.

Carlos Boudet, DDS DICOI

9/19/2013

You definitely need a new x-ray (a small intraoral periapical film will suffice) to see if there is bone loss around the implant due to the infection. It appears that your infection may complicate the healing and the survival of the implant. I would recommend that you go for a second opinion to an experienced implant surgeon. Unfortunately, your description and x-ray are not enough to determine what is going on and the dentist has to personally see you to recommend any type of treatment. Good luck!

dr Vinayak

9/20/2013

A second opinion would be beneficial. Pain could be due to lot of factors like ulcer, problem in adjoining teeth etc. It's better to rule them out before doing anything with the implant already placed

Dr. Samir Nayyar

9/20/2013

Hello First of all, ask your dentist to take x-ray. The picture would be clear in that. He'll definitely suggest you in a better way as your dentist can see it clinically also. If you can, do post the pic of the site as it won't be hard to take it etih your camera and if possible do post the fresh x-ray also. Best of luck

Andrew Rosen

9/20/2013

Thank you for taking the time to comment. I went back to the OMS today, on a slow improving trend on zithromax, but still with pain. I asked for an x-ray. He said no point, in his experience once a new implant starts to go bad like this, nursing it along never helps, and it needs to be pulled, and he did so. He indicated we we re-place (at no cost) in a few months. Thank you again.

Andrew Rosen

1/27/2014

Four months later and I'm back again. The dentist removed the implant, and about two weeks ago put one back in. Same issue, lots of pain and tenderness. Temporary improvement with 2 rounds of Zithromax (first round prophylactically staring on day of treatment), now following the same trend back to painful/tender. Interestingly, the same day he reinstalled the implant, he put one in the other side of my mouth and that one is completely fine. Questions: It looks like strike two. Could there be something inherent in this location that is causing the infection given the other side is fine. Should I keep trying, or call it a day and go for a bridge? Thanks.

Dr. Samir Nayyar

1/27/2014

Hello I'm sorry to hear this same thing from your side. Might be this area wasn't debrided (cleaned) properly while removing the implant as people do remove the implant and don't clean the area of infection properly or at all. I won't even think this from any dentist as all are very well qualified to omit this big thing. Hope for the best and have better luck this time.

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