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Advanced cosmetic and general dentistry

Why Did My Dental Implant Bone Graft Fail Three Times?

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I’ve had the same dentist for the past seven years and had no reservations about her placing my dental implants. Several co-workers referred me to this dentist, and three of them had great success with implants from the dentist.

My case must have been unusual for her because she said I needed bone grafting before getting my first implant. After four months, my dentist attempted the implant but said she needed to remove it because the bone was too shallow. I’ve had three surgeries, and I still don’t have a dental implant. I have much respect for my dentist, but I must ask, would I have had a better experience if I had chosen a specialist? – Thanks. Bennie from Tampa

Bennie,

While dental implantology isn’t a formally recognized specialty, some dentists, oral surgeons, and periodontists have advanced training in this area.

Model of a dental implant, including the crown, abutment, and artificial root

After successful bone grafting and dental implant placement, a cosmetic dentist can attach a natural-looking crown

We understand your dentist’s intentions and potential experience with implants. However, bone grafting is a complex procedure that requires specific expertise. Your dentist may be relatively new to this aspect of implant dentistry. Remember, every professional, even the most skilled, has a learning curve when using new techniques.

It’s commendable that your dentist is being honest about the situation. A less ethical practitioner might have proceeded with the implant, potentially leading to complications down the line.

Your dentist’s transparency suggests a commitment to a positive outcome. Dental bridges and implants are viable options for a single tooth replacement, each with advantages and disadvantages. If you prefer a dental implant, consider asking your dentist for a referral to a periodontist (implant specialist), or oral surgeon for bone grafting and implant placement.

After the implant heals, your dentist can restore it with a natural-looking implant crown.

Lowell, Massachusetts, accredited cosmetic dentist Dr. Michael Szarek sponsors this post. Read how Dr. Szarek strives to give his patients the best dental care in Lowell.

Why Does My Temporary Bridge Make My Face and Jaw Hurt?

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I have had a dental bridge since 2017 that includes my lower right first premolar through my second molar. Although the bridge was still comfortable, my dentist recommended replacing it before I began to have problems. She took impressions of my mouth and placed a temporary bridge. I take ibuprofen every day because the bridge hurts. The entire left side of my mouth and jaw hurt. It hurts to speak and chew more than anything, and my gums are slightly swollen. My dentist took x-rays and said they looked okay. She cannot explain my pain. Of course, I am not allowing my dentist to order the final bridge because this temporary bridge hurts so badly. My dentist recommended an endodontist, but I do not have an appointment until early next month. Why would I suddenly need a root canal? Based on my description, why would a temporary bridge cause ongoing pain? Thank you. Kurt from NH

 

Kurt

Thank you for your question. One of our dentists would need to examine your bridge, teeth, and X-rays for an accurate diagnosis. However, we will explain three factors that might cause a temporary bridge to hurt.

Why Would a Temporary Bridge Hurt?

Diagram of a dental bridge

Dental bridge

A temporary bridge can hurt because your teeth are sensitive after preparation, irritated by bacteria, or the bridge is not optimal.

  • Sensitive teeth after preparation – Placing a bridge requires shaving down teeth on the sides and top so the bridge ends will fit over them. Teeth prepared for a bridge can ache and be sensitive to cold and hot temperatures, food, and drinks. Removing a bridge and preparing teeth for a new one are traumatic events.
  • Irritation from bacteria – If a dentist finds decay beneath a dental bridge or its components, bacteria could have infected and irritated your teeth.
  • Bridge position – A bridge that does not fit well can affect your bite. When you eat, the opposite teeth (upper or lower) can hit the bridge teeth harder than usual and make them ache. You can feel jaw or neck pain and get headaches, too.

Referring You to a Root Canal Specialist

When a dentist cannot identify the cause of your pain, they may refer you to a root canal specialist (endodontist). The endodontist will examine your teeth, possibly x-ray them, and test their sensitivity.

Although some dentists delay making the permanent bridge, others place it with temporary cement. It gives the dentist time to observe your teeth and see if the sensitivity resolves. An X-ray will show whether the tissue inside the tooth is infected or died and requires root canal treatment. Prompt care can help preserve the tooth, preventing the spread of an infection or the need for a dental implant.

Lowell, Massachusetts, accredited cosmetic dentist Dr. Michael Szarek sponsors this post.

Why Do I Have Radiating Tooth Pain with No Cavity?

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I have radiating pain in my tooth, but no sign of a cavity exists. I think the worst and am concerned about needing an extraction and dental implant. What else could be causing the problem? Thanks. Gavin K.

 

Gavin – Thank you for contacting Dr. Szarek’s office.

Although you may not see signs of a cavity, the pulp of your tooth may be infected. Cavities or decay begin outside a tooth, but internal root absorption destroys tissue inside a tooth.

What Can Cause Tooth Pain Without a Cavity?

Conditions that can cause tooth pain without a cavity include the following:

  • A fractured tooth can cause persistent tooth pain. A dentist will use a bright light to reveal if your tooth is fractured.
  • Inflamed tissue. The tissue surrounding your tooth may be strained. The pain and inflammation in the tissue can transfer to your tooth.
  • Jaw pain. Facial pain, such as pain in your jaw muscles, can refer to your teeth.
  • Sinus problems can refer dull, aching, or throbbing pain in your teeth.
  • Headaches. Migraine and cluster headaches can refer to deep pain in teeth.
  • Cardiovascular problems. Heart problems can refer pain in the shoulder, neck, and even the jaw and cause pain in your teeth.
  • Nerve pain. Specific neurological issues can cause you to feel pain in your face, teeth, or gums.
Model of a dental implant, including the crown, abutment, and artificial root

Prompt care for tooth pain can decrease the need for removal and a dental implant

Schedule an examination from your dentist for an examination and x-rays. Call a dentist for an appointment. Your dentist will determine if your tooth is causing discomfort. Early detection can prevent the need for tooth removal and a dental implant.

Your dentist may refer you to a primary care doctor and perhaps to a neurological for further tests to identify and treat the cause.

Lowell, Massachusetts, accredited cosmetic dentist Dr. Michael Szarek sponsors this post.

My Tooth Broke at the Gumline and the Repair Is Unresolved

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Five months ago, my left front tooth broke at the gumline. Although my dentist said he would do an extraction and bridge, he did a root canal on the tooth instead of the extraction. My insurance company will not pay for the bridge because I have other missing teeth and one that requires extraction, so really, a bridge will not work. My dentist said he would give me a refund if I signed a waiver to agree that he is not responsible if I have problems with the tooth that broke at the gumline. I am wearing a poor-fitting partial flipper and waiting for a solution for the damaged tooth. My dentist wants me to pay for the flipper without telling me about the final solution. I do not think it is fair to ask me to sign a waiver. Should I accept the loss and go into debt for a dental implant? – Thank you. Tyrone  from Kansas City

Tyrone,

Your dentist is responsible for starting work that he cannot complete and switching treatment options on you without proper notice. We recommend that you not make any decisions before switching to another dentist. Do not sign a release.

Getting a Refund from Your Dentist

Picture of dental iimplant parts separate and put together

A dental implant can replace a tooth broken at the gumline

You can get a refund from your dentist by contacting these professionals or organizations for help:

  • A lawyer – Consult with a lawyer to understand your options for getting a refund and compensation for your discomfort. Get copies of your dental records before the consultation.
  • A cosmetic dentist – Look for a dentist with advanced cosmetic dentistry training—preferably accredited—to conduct a thorough exam and take x-rays to determine how to restore your teeth. The new dentist will likely be willing to confirm that your dentist’s work on your teeth was faulty. A dental implant is a reliable way to replace your missing teeth. Talk with your new dentist about payment plans or financing to make treatment affordable.
  • Your dental insurance company – Report the issue to your insurance company if it is involved. Your dentist should not receive payment for the care you did not receive.
  • The state dental board – Report the issue. Although your dentist may not receive a reprimand, reporting the problem can help prevent other patients from having a nightmare experience with your dentist.

 

Best wishes for a progressive and thorough resolution.

Lowell, Massachusetts, accredited cosmetic dentist Dr. Michael Szarek sponsors this post

Root canal treatment again?

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In 2014, my dentist did a root canal on an upper right molar. Two months ago, the tooth started hurting, and it’s getting worse. Will I need an extraction and dental implant, or if I see a specialist, can they try a root canal treatment again and prevent an extraction? – Thanks. Noble R. from CT

Noble,

Root canal treatment is one of the least predictable treatments in dentistry. Even if a dentist performs the procedure correctly, it has a 5-15% failure rate.

Can Root Canal Treatment Be Repeated?

Root canal treatment can be repeated multiple times. But it doesn’t always make sense to do it. Still, there is an option before extracting a tooth and replacing it with a dental implant.

Why Causes Root Canal Failure?

Sometimes root canal treatment fails because the dentist could not completely remove the infection from a tooth. Canals in a tooth can twist and turn and make it difficult or impossible for a dentist to clean out the infection and seal out bacteria fully.

The pulp in your tooth contains living tissue, nerves, and blood vessels. A pulp chamber is in the crown of a tooth, and a pulp canal conducts blood supply and nerve in the chamber. If tooth pulp is infected, a dentist will clean out the chamber and canal and seal them to prevent bacteria from entering the tooth.

Molar teeth usually have three canals for each tooth root. But sometimes a tooth has a fourth canal that’s difficult to find and clean. Some canals have branches at right angles. A dentist has tiny, highly flexible files to insert in the tooth and remove the infected tissue, but the files cannot enter a side branch with a right angle. Although a minority of teeth have fourth canals and challenging angles, sometimes fourth canals exist and retreatment is needed. Retreatment has a 50 to 75% success rate. But if retreatment is completed by a dentist who is skilled in root canal treatment and it fails, a third treatment is likely to fail.

Root Canal Surgery

Root canal surgery is a procedure that enters the tooth through the root instead of the crown. A root canal specialist, or endodontist, performs root canal surgery, or an apicoectomy. The treatment is 50 to 75% successful. The specialist will take the following steps:

  • Make an opening in the bone
  • Cut off the root tip of the infected tooth
  • Place a small filling at the end of the tooth to seal it

But even with an apicoectomy, a specialist sometimes can’t access tooth roots, or a root’s location—such as near a nerve in the lower jaw and lip—makes surgery risky.

Extraction Instead of Repeat Root Canal Treatment?

Diagram of three phases of dental implants, for information on implants and diabetes from the office of Lowell, MA dentist Dr. Michael Szarek.

Repeat root canal treatment is an option before extraction and a dental implant

An extraction is an alternative to repeat root canal treatment. Although it’s not the first choice, sometimes even a specialist can’t save a tooth, and you’ll need an extraction and dental implant.

Schedule a follow-up appointment with your dentist to discuss your options. You can compare your dentist’s recommendation with a second opinion from a root canal specialist.

Michael Szarek, DMD, a Lowell, MA, cosmetic dentist, sponsors this post.