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Dentistry/puss after sinus lift



A month ago I had a sinus lift, in order to enable an implant at tooth #3, and was on a course of antibiotics. I am also using salt water to rinse. I removed the stitches about a week ago, then, about four days ago, I noticed a swelling full of puss at the location of tooth #3 and close to tooth #2. When I pressed it, it drained and formed again. The same thing happened the following days.

I went to see the surgeon and he pressed the area, but no puss came out. I showed him photos that I took and he agrees that it is puss, but is not sure where it is coming from, e.g., the location of the stitches or from the sinus.

My guess is that if it is from the stitches, it should not be that much.

Any help?

ANSWER: Hany -  The infection could be from either location, but now that the sutures are removed a recurrance of the swelling infection would moreso indicate the sinus.  Just as another possibility, the infection could be from the graft material used in the sinus lift.  Well now it is sort of a wait and see process.  If the infection swelling recurs then the surgeon might have to be more aggressive to eliminate the infection.

I hope that it does not recur and you heal.  If you have additional questions, feel free to contact me again.

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Today, I saw the surgeon again and he took an X-Ray. He mentioned that I lost most of the bone graft that was done for the ridge expansion due to the infection. He gave me another course of clindmycin, with a lower dose of 300mg every 6 hrs. He also mentioned that when he puts the implant in few months he will add more bone to compensate for the lost bone to expand the ridge.

My questions are:
1. is it enough to use the antibiotic?
2. how feasible is it do the ridge expansion at the time of the implant and would that be easy compared to the sinus lift operation?
3. should I be concerned about the bone that was grafted in the sinus lift.

Many thanks

ANSWER: Hany - Antibiotics are important now, but it will not remove all of the infection until the cause of the infection is determined.  The cause has not yet been determined so nothing aggressive can be done now.  Ridge expansion at the time of the implant insertion is not a bad idea, unless you are having a reaction to the artificial bone.  You need to be concerned and the viability of the graft, to you, is important before it is redone. That means that the graft material should be tested for your acceptance.  

So some testing needs to be done before anything else is attempted.

---------- FOLLOW-UP ----------


Many thanks for your answers.
Now, how can the cause of infection be determined and how to make sure that the infection does not spread?

My surgeon told me that 3 months after I take the antibiotic he can do the augmentation and implant. He did not mention anything about how to make sure that the infection is eliminated completely. He also does not know where it is coming from.

I do have pain and I am thinking that the puss needs to be drained. Am I correct?

Thanks a lot.

Hany -  If the pain is a throbbing pain, it is then due to an infection.  Just setting a time limit is not correct.  Usually if the cause of the infection has been eliminated, then treatment can be rendered 4-6 months later.  If you have any symptoms of an infection(swelling, throbbing or pain) it must be gone for 4-6months before anything is done in the area.  If you are feeling a pressure pain, possibly with a throb, then it needs to be dreamed.  

So if you still do have pain, the surgeon needs to determine the cause first.  Just setting a time is wrong.  The surgeon cannot set 3 months of after taking the antibiotic if symptoms are still present.  So symptoms need to be gone.  The surgeon needs to be sure before any work is done in the area.


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Joel S. Teig, DMD, Diplomate ABOMS, retired


I am a board certified oral and maxillofacial surgeon and I am available to answer questions related to tooth extractions, implant insertion, facial recontruction, facial and oral tumor removal, TMJ dysfunction and various successful treatments, including surgery if all else fails, and occlusal discrepancy requiring orthognathic or jaw surgery.


Board Certified Oral and Maxillofacial Surgeon practicine for over 20 years. Assistant Clincal Professor and State University School of Dentistry.

American Dental Association, American Association of Oral and Maxillofacial Surgeons, American Board of Oral and Maxillofacial Surgeons

BA -University of Connecticut DMD - University of Pennsylvania School of Dental Medicine

Awards and Honors
National Honor Society (OKU), Philadelphia County Dental Society, Mosby Book Award, Oral Surgery Honors, Summa Cum Laude

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