Antibiotic and Immediate Implant

Mr. Tang is 86 year old.  He has several missing teeth, including #19, and 20 (Fig.1,2).  The tooth #21 has broken down to its root.  Three implants are planned in this area in one appointment, including #21 ext and immediate implant.  CT shows that there is infection around the root tips of #21 and 22.  Root canal is done for #22 before implants to get rid of infection associated with this tooth (Fig.7 *).  An antibiotic has to be taken before extraction to control the infection associated with the broken root.  But Mr. Tang did not follow the instruction without letting us know.  His reasoning is that he does not have any pain after root canal.  His body is strong enough to fight any remaining infection.

Fig.3 shows that the broken root is removed (black area) with infection area labeled as red.  To place an immediate implant, drills (Fig.4 white line) have to be used to extend the socket as long as possible.  A long implant will be stable.  The root tip infection, although mild, causes pain when drills are being used, in spite of several injections of an anesthetic.  Too much anesthetic is not a good idea: with complete numbness, drilling may be deep to injure the nerve underneath (Fig.5 N).  To compromise, a small and short implant is placed at the site of #21, as compared to that at #20 (Fig.6,7).  One month later, the immediate implant is not stable with space around it (Fig.8 arrowheads), while the other 2 implants are normal.  The mobile implant has to be removed; everything has to be done again.  When we double check Mr. Tang's history of antibiotic before the 2nd surgery, he reveals that he did not follow the instruction for the 2nd time.  He was reluctant to take the medicine in the office.  When the implant is removed and drills (Fig.9 D) are being used around the infected area, he experiences pain.  With sound anesthesia, repeated X-ray and careful measurements and adjustment (Fig.10), a larger and much longer implant is placed with stability (Fig.11,12).  When infection is under good control, implant placement, no matter whether immediate or not, should be painless.

The second time he is going to have implant placement, the patient takes antibiotic faithfully.  One week after surgery, he calls our office to request more of antibiotic when he feels a little pain around the wound.  In fact he is doing great.  No wound infection occurs.

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Xin Wei, DDS, PhD, MS 1st edition 01/04/2015, last revision 08/30/2015