Expert: Lawrence Spindel DDS, www.lspindeldds.com - 11/9/2009

Question
I will try my best to make this short. I have had severe complications (in my belief) from an extraction/bone graft completed on 8-26-09. Initially I had a re-treat on 1-28-09 on a root canal completed in my teenage years, I wore the temporary for 3 months with no problems, had the permanent crown placed with laser cutting of the gums and in July started having problems with not being able to chew. Went back into the dentist and was told food most likely caused irritation and to come back in 2 weeks (in August). Went back in and wouldn't you know- full blown abscess. After the x-ray it was shown that the root had fractured so it would be said that I had to have an extraction on tooth 14 and bone graft. I went to a cosmetic dentist on 8-19-09 and the same treatment was suggested and began Amoxicillan 500 3 times a day for 7 days. On 8/25/09 went back in due to excruciating pain and an emergency surgery was completed on 8/26/09 (more antibiotics- Clindimycin 150mg 3 times daily X 10 days). They said the "source" of infection had to come out (understandable), when they did the extraction they also did a bone graft on tooth 14 and treated the front and back tooth for a bridge (3 hour surgical procedure). I have been back to the cosmetic dentist on 8/28/09 (occlusion adjusted), 9/7/09 (labor day visit to emergency room diagnosed with severe sinus infection- antibiotics prescribed Clindimycin 300mg 3 times daily for 10 days) 9/8/09- (view area for possible infection seen by emergency room doctor), 10/6/09 (severe sensitivity to area of 3 teeth treated- was told tooth 13 needed root canal %26 bone spur coming out of jaw needed to be shaved down), 10/7/09 (root canal completed on 13 and misunderstanding so # 15 root canal completed as well-bone spur opened and shaved down), 10/14/09 (sutures removed and replacement temporary made, final impressions done). 10/24/09- major facial and gum swelling on left side of face. 10/29/09- second opinion from Oral Surgeon found bone graft is failing, possible gum graft needed to fix receding and root canals have severe voids. 10/30/09- cosmetic dentist views area- he says nothing noticeable for failure- another script for Amox. 500mg 3 daily for 10 days, Ibuprofen 800, oral rinse aid morning and night.
Area seems a little better this time, but still have swelling on very back upper tooth area, cant chew on left side and complications with another sinus infection, throat irritation (red and swollen) and overall not feeling well. Question: Could the way I have been felling have anything to do with the tooth that I have had issues with? I am suppose to have the bone graft removed and re-treated but I am afraid the sinus cavity is now an issue (no issues before all this work). I don't understand how I could possibly be getting sick if I am on antibiotics again, unless my body is unresponsive due to all the previous treatments with the meds.
I don't know what to do or who to talk to. I am so confused and at my wits end with dealing with pain and constant sinus issues. Any help would be greatly appreciated.
I know this is very long, but I have been dealing with this for months now and I am still awaiting word from my Oral Surgeon to see if my insurance will approve the removal and re-treat of the area. Could it be possible I may need to have a sinus lift?
Sorry this is so long.......

Answer
Dear Tia,

Although it is not possible for me to diagnose your problems without a physical examination, I will try and help if I can from afar. From your narrative, it does sound likely that your current problems can be traced back to the extraction of tooth #14. Sometimes bone grafting doesn't work and it may need to be removed before it gets better.  

In my practice, after an extraction I wait at least several months before taking a final impression for a bridge, in order to insure complete healing before making a permanent prosthesis.  If a patient is symptomatic, it is usually not advisable to complete a case. If your graft will have to be removed, I do not advise you to have the permanent bridge inserted until a new graft is placed and adequate healing occurs.

If the permanent bridge is inserted and afterwards you have the pontic area operated on, it may no longer fit the gum area properly. If you are uncertain about whether your graft is Ok, I suggest a second opinion from either another oral surgeon or a periodontist. If you have an infection at the extraction site of tooth #14, it often cause sinus problems as well. I am not sure why you need a sinus lift, but you should ask the oral surgeon about this.

I hope this information is helpful and please feel free to contact me again with any future dental questions.