Dear Dr Teig,

I was mugged back in November (long story)ended up being dragged by motorbike by my bag- fractured jaw, surgery 4 metal plates 2 missing teeth.

More recently my surgeon replaced my missing teeth with implants. The front canine was fairly straight forward, but she did say that the upper back molar was a little more complicated as the bone was to small and she would need to put bone graft in. So she drilled, then put in bone graft (cow apparently which kind of freaked me out) and then followed by implant. She told me that the 'tapping' technique was less costly than open technique and then after drilling as much as she could, proceeded to what felt like not tapping but hammering the implant further and further in to get the bone graft up. I have never had such an invasive violent experience before in my life and I found having my whole skull vibrating from the hammer hammering in this implant quite traumatic and upsetting. Anyway she eventually got it as far as she needed. When it came to seeing the final X ray. she said it was fine, except some excess bone graft material had gone above and perforated my sinus membrane. She said it should be okay but not to blow my nose! I am just a bit anxious, and wondered if I could have any thoughts/feedback. I also noticed today that in addition to feeling a little pressure in my right nostril, that my lymph node under my right jaw-just next to the jaw bone near the neck is swollen and sore. Thanks for your time, Julie

Julie - I have to tell you that your doctor was abusive to you.  First of all, there should be no difference in fees between the two types of implants.  One of the main problems with tapping the implant into place on the upper jaw is that it is difficult in controlling the depth of the placement by tapping vs the screw one.  For that reason alone, because the sinus is above the teeth in the upper jaw, it is important to control the placement of the implant.  I am not surprised that the surgeon perforated into the sinus.  As long as that is completely sealed, and no saliva from the mouth can enter into the sinus it should heal.  If there is any leakage, that could possibly be producing the symptoms of pressure and nodal inflammation.  Watch the situation carefully and if it gets worse or remains the same for a long period of time let the surgeon know and some further treatments may be necessary.


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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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