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Perforated Sinus During Dental Implant Procedure

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I had a failed dental implant procedure and the dentist recently removed the implant. He said there was no trouble removing it because the implant had not integrated with the bone at all. During the procedure, the sinus cavity was perforated by a few millimeters, which my oral surgeon says happens all the time. At that time of the removal, he said there was no need to do any preventative antibiotics. He did suggest I take Flonase as well as be gentle with the area. Though he stitched the gums, he said there was no need to close up the sinus cavity because it will heal on its own. He wants me to wait a year and then we will try again for the dental implant. A few days later, I started having congestion and this weird crackling sound even though I was taking the Flonase as instructed. I went back to have him look at it and he said for me to be patient. I told him I felt I needed an antibiotic. At first, he said no but I pretty much insisted. He finally gave me some antibiotics and I started feeling better and everything cleared up. My question is would it have been better to get the antibiotics during the removal procedure to prevent this?

Leslie

Dear Leslie,

illustration of a dental implant next to a tooth

While the way he handled the antibiotics is fine, I want to let you know that there is something much more concerning about this whole situation, which is the sinus perforation itself along with the lack of integration with the bone. While there are times that a sinus cavity will be perforated, a few millimeters is way too much. That is a huge distance by dental standards. Additionally, most of the time this is completely avoidable with adequate diagnostics.

Before letting him work on you again I would want to know two things. First, what diagnostics will he do in order to prevent this from happening again? Secondly, why didn’t the dental implant integrate with the bone? That will be important to know. It is standard procedure for him to do x-rays to ensure there is adequate bone there to begin with. This should have included a CT scan to ensure that something like a sinus perforation doesn’t happen. Placing dental implants is a three-dimensional procedure and requires three-dimensional diagnostics.

My suggestion is you make sure he can answer these questions before moving forward. It would also be helpful for you to get a second opinion on your case to give yourself the best chance of a successful outcome.

This blog is brought to you by Duluth, GA Dentist Dr. David Marion.

Bone Grafting Didn’t Work. Now What?

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I don’t know if third time can be the charm for me or if I should just give up. My dentist has placed many dental implants over the years so I felt fairly confident going into my dental implant procedure. Unfortunately, once he got in there he realized there was some problem with my bone structure and did not place the implants. He suggested we do a bone grafting procedure and then try again. I agreed and off we went to the bone grafting procedure. After the specified period of time, we went in for a second stab at the dental implants. Again, he said there was still not enough bone and he thinks I should just get a dental bridge. If I absolutely must, I supposed I must. However, I’ve invested so much in there and really wanted an implant. Is there any chance I can get one?

Kevin

Dear Kevin,

illustration of a dental implant next to a tooth

I believe it is still possible for you to get a dental implant, however, you may have to do it with another dentist. One with stronger implant credentials and experience. I don’t want to be hard on your dentist. He actually sounds like one who has integrity, a passion for getting it right, and is upgrading his skills. Those are fantastic things to have in a dentist.

Some dentists, with less integrity than your dentist, would try to save themselves the embarrassment of saying their procedure did not work and just go ahead and place the dental implant. Then, in a year or so, the implant would fail. You would have no idea it was because of something your dentist did wrong. Instead, your dentist did what was best for you in the long run.

It sounds like, though he has done many implant placements, he is new to doing the bone grafting. This is also a good quality in a dentist. It means that he is actively working to learn new skills and have more options for his patients. Most dentists who do dental implants don’t even try bone grafting and will just have you get a dental bridge just saying you don’t have enough bone for an implant. I would not give up on him as your dentist. You definitely have a keeper. I just think this one procedure needs someone a bit further along.

So, who should you get? I would look at the implant credentials on Dr. Marion’s bio to give you some idea of the type of training and experience you will need for this.

This blog is brought to you by Duluth, GA Dentist Dr. David Marion.

My Implants Fell Out the Next Day

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I had four dental implants placed. I just received the crowns and two of them have already fallen out just a day later. Dental implants aren’t cheap and I know my dentist is expecting the second half of his payment soon. I don’t feel I should have to pay for them if they fell out this quickly. He said they’d last years. Is this fixable? Should he re-do them?

Laurie

Dear Laurie,

illustration of a dental implant next to a tooth

There is something seriously wrong here. You’ve lost half your dental implants in one day. I feel fairly confident the others will not be far behind. You need to contact your dentist and let him know what is going on right away.

To answer your first question. No, you should not have to pay for these. It’s a pretty basic standard to expect your dental implants to stay in. While these can be re-done, you need to be certain your dentist can tell you why they failed before moving forward.

Reasons for Dental Implant Failure

You should know, that dental implants have 95% success rate, so what you’re experiencing is unusual. When dental implants do fail, here are some of the main reasons. Notice that most of them are a failure on the dentist’s part.

  • Infection. This often results from poorly fitting implants.
  • Subpar implants. Some dentists will cut costs by ordering cheap, overseas implant fixtures. These are rarely as well made as those that must adhere to the standards here in the states.
  • Inadequate bone. Your dentist should do enough diagnostics at the beginning to ensure you have the necessary bone structure to retain the implants.
  • Placing the dental crown prematurely. The waiting period between the surgery and crown placement isn’t just about healing. It’s also to make sure the bone has had adequate time to integrate with the implants and keep them secure. If your dentist puts the porcelain crowns on before that time, the load will be too much and will loosen the implant fixtures.
  • Incorrect surgical placement of the implant.

Once you find out why this happened, you can have it re-done (at your dentist’s expense). Unfortunately, you will need to have an additional procedure done first to get your jaw in a position where it can accept implants again. You’ll need to have some bone grafting done. Then, once you’ve healed from that, you can start over.

This blog is brought to you by Duluth, GA Dentist Dr. David Marion.