Q: Dr. Crapo: Two days ago I went to see my dentist for a checkup and cleaning. I’ve needed an implant but have been putting it off. The hygienist noted that we’d talked about it and brought up the subject again. I said I was still thinking about it, not wanting to get into my real reason. When my dentist came in he checked my teeth and said things looked fine; then asked about my missing tooth. In an instant, I decided to come clean so I said “I don’t know what to do, my brother had one, it got infected right off the bat and had to be removed”. My dentist said he hadn’t seen that happen before but the specialist he refers his patients to would be able to answer my questions. I don’t want to go somewhere else to be talked into something that scares me. How often does my brother’s problem happen and will it happen to me? I don’t want a bridge but I know the space is affecting my smile – it’s the second tooth behind my upper right eye tooth. Do you have any experience with this? Please advise?
A: Many years ago, when I was taking my implant training, I watched a surgery for a young girl who had lost her upper lateral incisors (the teeth beside her upper front teeth). The surgery that was performed for both implants was identical. The next month when we gathered to observe and perform implant surgeries, I was interested to see this young girl scheduled for implant removal.
After she was prepared for surgery we asked why one of the implants was failing. At first, the director of the course, who had placed the implants, said there wasn’t an apparent reason but turned the question back on the group (sort of like “House”) asking what we thought. Several ideas were presented – too much trauma caused at placement, the patient not following post-op instructions, and one I hadn’t heard before – drilling into a latent abscess.
When a tooth is extracted the socket must be carefully examined and explored to insure no infected tissue is left behind (the abscess). Many times, the socket is not thoroughly cleaned out and the body heals over it.
When an implant is placed years later, and part of the “quiet” abscess is encountered unbeknown to the surgeon or patient, it can flare up and cause failure of the implant. When this happens, the implant must be removed, the area completely and thoroughly cleaned out and bone grafted before a new implant is placed.
I know this might not be reassuring but the surgeon will make good on the cost and care of these problems. This is a rare occurrence, so don’t be put off. The chances are less than 1% that you’ll have problems.