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Question
Dr. Tieg,
I had an auto accident 20 years ago and lost 1 tooth on top (had an implant) and broke 2 others on each side of implant (had root canals & crowns) to repair.  
Fast forward... My Dental implant is fine. 1 tooth with root canal & crown has a major infection to the right of the implant and needs to be removed. When he took X-rays, they show severe bone loss on this tooth. They also show some on 2 teeth on other side of implant as well. He thinks that over time the bone loss will continue.  
My oral surgeon wants to bone graft across all 3 teeth that were injured and one additinal adjacent tooth. Also, clean out root of other tooth not being removed (that has a root canal and crown) & place an implant (where the infected tooth will be removed).
Thoughts?
Thank you in advance for your time!

Answer
Jay - Of course without seeing xrays or examining you, it is a little difficult for me to be completely sure, but with the bone loss in the area, there is problem some chronic low grade inflammation or more likely infection that is working on the bone and breaking it down.  Stabilizing the teeth with a graft and cleaning any infection around the root sounds appropriate.  My only recommendation is that all inflamed or infected tissue is removed and the area be left for a while so no active bacteria is present.  After waiting a month or two to make sure no more bacteria is working in the area and creating infection or inflammation, the surgeon should then place the bone graft.  I am very conservative and don't believe in rushing any treatment until all signs of infection are gone.  Likewise the implant should not be placed at the same time the infected tooth is removed.  The socket needs to heal without infection (3-4) months before the implant is placed.

If you have additional questions, feel free to contact me again.

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Joel S. Teig, DMD, Diplomate ABOMS, retired

Expertise

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.

Experience

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

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

Education/Credentials
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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