Extraction and Bone Graft

[LaurelB]

I found out recently that I apparently need to have a root canal tooth extracted (a bottom molar; tooth 30). It is not infected, but the crown became loose and caused some slight decay underneath. When my dentist went to remove the decay, the tooth was so thin and fragile that it fractured below the gumline.

I am bedridden with severe ME, so this of course creates some issues for me. My dentist is willing to do the extraction at home, but also wants to do a bone graft (an allograft using freeze dried cadaver bones... ew) prior to building a bridge to replace the tooth. This will all, of course, cost me a substantial amount of money.

My main concern is that my naturopathic MD does not feel I should get the bone graft due to potential immune system issues. He apparently knows someone who had a bad reaction. Meanwhile, my dentist says if I don't have a bone graft, I risk bone loss and having a large dip in that area of my mouth, which could lead to problems in the future.

So, I don't know what to do. I would love to save the tooth, but I don't know if it's possible. Being bedridden, it's difficult to get a second opinion. I do not have an x-ray of the tooth to send to another dentist, as my dentist did not take one after it fractured.

Anyway, my question in all this mess is, has anyone here with severe ME had both a molar extraction and bone graft, and if so, how did you hold up? Any negative reactions to the graft (rejection, infection, worsening of symptoms, etc.)? Has anyone had a molar extraction without then getting a bone graft? If so, did you have any issues as a result (such as bone loss or collapse of adjacent teeth)? Thanks for any input.

 

[Crux]

I don't fit all of the criteria here but, here's my experience :

I recently had an extraction of a front tooth, #7, although changed because of past extractions for braces.
Years prior to that, I've had the 2 front teeth and a canine extracted. I've had 4 bridges. 3 failed because of infection.

With the last extraction, a bone graft was used. I took antibiotics and seemed to recover fine.

I take Hydrocortisone. I stress dosed for the procedure, and IV demerol was used. ( have had bad reactions to nitrous oxide)

The complicating factors are : I let the oral surgeon put in 3 implants. I have rather severe osteoporosis ; he had to hammer them in because the bone was too soft. He used more bone grafts. One of the implants became infected. I'm on more antibiotics.

I figured out that there is a channel from the sinus into the mouth. (oroantral communication/fistula) Sinus bacteria are leaking into the tissue surrounding one implant. ( The other two seem to be ok)

Taking antibiotics orally has been a problem because they are not getting into the oral/sinus area very well. The side effects of the prolonged high doses are also painful.

I'm attempting to remedy this by making an antibiotic solution, and adding it to the sinus with a dropper. I'm also swishing the solution in my mouth. ( I can't recommend this to anyone else, but it's helping....at least the pain has stopped)

I guess the points I'm trying to make are :
We may be Very prone to infections, so take precautions.
Also, rejection of bone grafts are rare, but possible. In my case, the bone grafts have not been rejected.

 

[Invisible Woman]

I have moderate/severe ME. Often bedbound, usually housebound but I can get out (with help) now and then.

I had a molar removed and a dental implant put in place with bone graft/packing around the implant. I couldn't have this done at home so the work was done at my dentist's over a number of visits.

First the extraction & then I had some slight inflammation, but that settled down quickly. This was allowed to heal for about 3 months. Then the implant was fitted (basically a titanium screw) and the area was packed with a little bone graft. Then this was allowed to heal and finally a crown was put on top.

I cannot tolerate injections with adrenaline so we used a local that doesn't contain it.

I can honestly say that I didn't have any problems at all. The most painful part, quite frankly, was paying for it all.

Like you I was told that I would be likely to have problems without the graft.

Subsequent x-rays haven't shown any problems either.

I don't know where the bone used came from@LaurelB, but I can find out for you if it helps?

 

[LaurelB]

Thank you for the replies and descriptions of your experiences. It is helpful. Invisible Woman, my understanding is there are 4 different types of bone grafts: autogenous (your own bone taken from elsewhere on your body), allograft (living donor or cadaver bone), xenograft (taken from cow) and alloplastic (synthetic material). So, if they didn't take from your own bone, you likely had one of the other three. They are all supposedly safe, but there is risk of infection an rejection and I just don't want to create possible problems for myself if it can be avoided, especially if my doctor feels it's a risk for me. My understanding is that it's primarily cosmetic, and generally used for preparation of implants more than it is for bridges. I'd be getting a bridge. But my dentist is still suggesting the graft regardless and I can't get a second opinion, so it's just really hard to know what would be best.

Thanks again for the input! Good to know neither of you had issues with the graft itself. Whether I get the bone graft or not, I will definitely be put on antibiotics prior to and following the extraction. Hopefully there are no issues.

 

[Invisible Woman]

My understanding is that it's primarily cosmetic, and generally used for preparation of implants more than it is for bridges.

I was told that when you remove the tooth itself there is bone shrinkage. Putting an implant in reduces this to a certain extent - partly I think 'cause it takes up space and also because it takes some pressure when you bite or chew and this "loads" the bone and helps prevent further shrinkage.

Just removing a tooth will cause shrinkage and presumably if you create a bridge for that gap then over time the bridge may no longer fit as well as it did initially or may even need to be replaced eventually.

Here is a PDF from a UK hospital re grafts - it is primarily about implants but does mention that if there is not enough bone in the jaw then it may be necessary for bridges as well.