imageFor my last 2 postings, I discussed what happens during implant surgery in a relatively “healthy site” but all this changes when the patient needs the tooth removed because of a bad infection. By a bad infection, I mean one that cannot be resolved with simple antibiotics, the area is possibly inflammed, sore and red and may even have an active abscess with pus (yuck!!) draining from the gums around or above the tooth.

Tooth with draining abscess.  This is caled a fistula.

Tooth with draining abscess. This is caled a fistula.

When this situation is present, the primary concern is getting the site “clean” of infection, the patient comfortable and allowing the site to heal.

Since bone grafts rarely work well in an infected site, the surgeon will usually chose to avoid this procedure at this time.

So what is the course of action for an infected site?….Well of course, it depends!
So let’s go through the different scenarios.

1. Infected tooth with no loss of gum tissue (receded gums) and/or minor bone loss from the infection:
In this case, the surgeon just needs to wait for the infection to heal. This usually occurs quite quickly after the tooth has been removed, usually within 10-12 days.  The surgeon should be able to place the implant into the now clean site with the only necessary bone graft, that being to fill the gap between the implant and the walls of the socket.
2. Infected tooth with receded gums and possible bone loss:
In this case, the surgeon will have to wait for new gum tissue to grow and the gums to heal over and close the socket (around 6-8 weeks).  The sugeon  can then place the implant with some bone grafting for additional support on the implant
3. Infected tooth with heavy loss of bone:
When the infection  is bad, it can literally disolve the bone in the site and cause a heavy loss of bone. When this happens there will be insufficient bone to provide any stability to the implant. So before if can be placed, the bone must be regrown (by bone augmentation). In this situation the surgeon will have to wait the necessary 6-8 weeks as above for the gums to heal over, and then she can rebuild the bone with bone grafting. In these cases, the patient will have to wait another 6 months for  this new bone to fully mature and be strong enough and only then can the surgeon place the new implant.

Once the new implant is placed, your dentist can build a new tooth on it anywhere from 4-9 months depending on many different factors.

So, these are the different choices faced by your surgeon when replacing your infected lost tooth.

Next blog, we will talk about the changes to these scenarios if the tooth is in what we call the “Esthetic Zone”. (Something different from the “Twilight Zone”)
Stay tune to learn more about how to avoid an ugly front tooth replacement.