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Dentistry/Apicoectomy - bone grafting & implant


Hi, I have read an answer given by you to Wendy, which is why I decided upon you to answer my question.  My daughter had two abscesses and in both the instances had an apicoectomy performed, both occasions in hospital under anaesthetic.  The last apicoectomy about four years ago.  During 2013 the abscess recurred (evertime the same spot).  She was advised to have a dental implant.  She was on antibiotics for approximately four months and then she had the abscess (apparently) removed, bone grafting (augmentation) was done and the first step of implant was also done, ALL SIMULTANEOUSLY.  This was not done under anaesthetic.  Within three days she was taken to a another dentist who referred her once again to a dental surgeon as it seemed as if the abscess was still there.  Within a weeks she went to a different dental sureon (as the surgeon who did the work the first time was on holiday overseas) who placed her on antibiotics for two weeks;  after two weeks she went back and the abscess was removed as well as the dental implant.  Bone grafting was done once again which failed and after three months bone grafting was again done which once again failed.  Eventually one year after the (apparent) initial removal of the abscess, bone grafting and dental implant, it was decided that she will rather get a bridge, which should have been advised initially before the dental implant as she has a heart condition and is smoking as well.  After about nine months she is so happy with the bridge, never had any problem and smiles all the time.  I would like to know, taken her history about abscesses and two apicoectomies into account, when the abscess was (apparently) removed the third time, should there not rather have been a waiting period (say three to four months time) before the bone grafting and dental implant take place, mostly in order to make sure that infected area (abscess) has completely healed?  If any infection was left behind obviosly it would spread and bone grafting would not succeed which then leads to taking out just about everything.  I thank you in anticipation.  Regards.

Rencey - Unfortunately you have learned what many dentists don't know or choose not to follow.  If a surgical area is promoted as a site for a dental implant, there cannot be any signs of infection for a minimum of 4-6 months before any attempt at bone graft or implant placement.  The time which is waited allows for a complete resolution of any remaining bacteria plus, just as and maybe more important, it allows for blood vessel growth within the bone and healing of the bone.  Without the blood vessel re-development the bone will not heal properly and any attempted surgery of apicoectomy or implant placement has a much less chance of success  

So unfortunately you have learned more than many dentists.  After an infection, WAIT and don't rush to do surgery.


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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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