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Extracted Tooth, Implant, and Sinus Lift

User Level:
Patient
Posted by: ken.wilner  (9 years ago)
A failed root canal for an abscessed tooth performed by my dentist resulted in my tooth (3rd molar upper) needing to be extracted.

My dentist recommended:
1. Immediate extraction of tooth.
2. Immediate socket bone graft.
3. Implant performed later

Additionally, the dentist thought is was highly unlikely that a sinus lift was needed.

My oral surgeon recommended:

1. Immediate extraction of tooth.
2. No socket bone graft so that infection could heal. Thus leaving the socket to naturally fill in.
3. 3 month's later, do a CAT scan to determine if a sinus lift is needed, and determine a plan.

In this case, my oral surgeon thought a sinus lift was almost certainly going to be needed.

When I asked the dentist about the differing views, he said "of course the surgeon want to do a sinus lift...he's a surgeon".

When I asked the surgeon about the differing views, he said "the dentist does not have the technical skills or experience to know if a sinus lift is needed or not".

A number of questions.

1. Which strategy should I go with? How do I resolve the differing views?

2. Since the infection was still present after extraction, was the dentist incorrect that a socket bone graft could immediately be performed?

3. Is the any harm in waiting the 3 months after extraction to do a bone graft and/or start the implant process as the oral surgeon suggested? Will that time period increase the likelihood that a sinus lift will be needed due to bone lost during that time?

4. Is a sinus lift typically needed for an upper back molar implant if the process is started immediately after extraction?

User Level:
Dentist
A failed root canal for an abscessed tooth performed by my dentist resulted in my tooth (3rd molar upper) needing to be extracted.

My dentist recommended:
1. Immediate extraction of tooth.
2. Immediate socket bone graft.
3. Implant performed later

Additionally, the dentist thought is was highly unlikely that a sinus lift was needed.

My oral surgeon recommended:

1. Immediate extraction of tooth.
2. No socket bone graft so that infection could heal. Thus leaving the socket to naturally fill in.
3. 3 month's later, do a CAT scan to determine if a sinus lift is needed, and determine a plan.

In this case, my oral surgeon thought a sinus lift was almost certainly going to be needed.

When I asked the dentist about the differing views, he said "of course the surgeon want to do a sinus lift...he's a surgeon".

When I asked the surgeon about the differing views, he said "the dentist does not have the technical skills or experience to know if a sinus lift is needed or not".

A number of questions.

1. Which strategy should I go with? How do I resolve the differing views?

2. Since the infection was still present after extraction, was the dentist incorrect that a socket bone graft could immediately be performed?

3. Is the any harm in waiting the 3 months after extraction to do a bone graft and/or start the implant process as the oral surgeon suggested? Will that time period increase the likelihood that a sinus lift will be needed due to bone lost during that time?

4. Is a sinus lift typically needed for an upper back molar implant if the process is started immediately after extraction?



Why would anyone want to replace a WISDOM tooth with an implant???????? 2nd molar implants are hard enough to do.

You ALWAYS preserve bone by doing a socket graft. But it is true- these can only be done after the infection clears. 3 months afterward is too long and probably would do no good. It should be done 1-3 weeks afterward.

On a case like this, after healing, you always want to do a CAT scan to determine how much bone is left. Patients are lucky in this area to have enough bone to place a 10mm implant. At the best, perhaps it can be done with a CLOSED sinus lift rather than an OPEN one. Closed sinus lifts are less traumatic and less money.

The success rate of implants drops to 90% in this area, due to bone density.
Posted 9 years ago
User Level:
Patient
Posted by: kcdubuya  (9 years ago)
I'm sorry. I got the terminology wrong. It is not a 3rd molar(wisdom tooth) as those are already gone. It apparently is a 2nd molar.

So my conclusion of your answer is that based on the info I provided you are not happy with either approach. You don't like the dentist's approach because there is no mention of a CAT scan to determine bone density. You don't like the oral surgeon's approach because he is waiting too long to do anything.

Assuming I got this all correct, what would you recommend at a next steps? Get another opinion from a different oral surgeon? It has been less than a week since my exraction.

Thanks.

Ken
User Level:
Dentist
I'm sorry. I got the terminology wrong. It is not a 3rd molar(wisdom tooth) as those are already gone. It apparently is a 2nd molar.

So my conclusion of your answer is that based on the info I provided you are not happy with either approach. You don't like the dentist's approach because there is no mention of a CAT scan to determine bone density. You don't like the oral surgeon's approach because he is waiting too long to do anything.

Assuming I got this all correct, what would you recommend at a next steps? Get another opinion from a different oral surgeon? It has been less than a week since my exraction.

Thanks.

Ken


Patients are usually very short of bone after a second molar extraction. So it is usually a good move to graft immediately after the infection cleared. At the least, it may make it possible to do a CLOSED sinus lift rather than the more expensive OPEN sinus lifts. Then take a CAT scan after 4 months of healing.

This was the protocol in my own mother's mouth. If I had not done the socket graft, the sinus lift would have been much more difficult.
Posted 9 years ago
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