Today I had the opportunity to explain to a new patient about the proper treatment protocol for a tooth that she is losing. Here is a great lesson about what to do when you are about to lose a tooth.
The patient was told by her previous dentist: “Your tooth has a infection. Let’s put you on antibiotic. Then…you come back for us to extract the tooth and to do some bone graft. Then…TWO WEEKS LATER … we can prep the adjacent teeth for a bridge to replace that same missing tooth.”
I have never heard of any bone grafting material that can fully stabilize an extraction site in TWO WEEKS. A typical bone grafting site requires any where from 4 to 6 months of healing time.
In addition, the tooth behind this failing tooth is also compromised. Using it to anchor a bridge also will not provide the patient a predictable long term result.
In a case like this where an active infection is present due to a failed root canal treatment with compromised root structure we must be even more careful with our treatment plan. A Gum Specialist (periodontist) or an Oral Surgeon would be best to handle the surgical aspect of this tooth. The proper treatment sequence would follow something like this:
1. Antibiotic Regiment to suppress the infection
2. Extraction of the failed tooth with proper bone grafting done at the same time
3. Wait for proper healing. Typically 4-6 months
4. Placement of the dental implant to replace the missing root
5. Wait for proper healing. Typically another 4-6 months.
6. Placement of a new crown on top of the dental implant.
As a patient, you need to be educated enough about a complex procedure before agreeing to the recommended treatment. Dental Implant treatments require proper coordination between a surgeon and a restorative dentist in order to achieve a successful outcome. This patient had made a very wise decision to seek multiple consultations with different dentists before choosing her own treatment choice.
Let’s take a look at the tooth:
√ The furthest left arrow points to the compromised root which was proposed to be the anchor for a new bridge.
√ The middle arrow points to the fractured root of the tooth in question.
√ The right arrow points to the infection and bone loss around the infection.
Alex Nguyen, DDS is a Saratoga Dentist who practices General Dentistry, Cosmetic, and Implant Dentistry. For over 20 years the practice has been serving the residents of Santa Clara County and San Francisco Bay Area.