HomeAnswersOral and Maxillofacial Surgeryroot canal failureKindly interpret the scan results after the RCT failure.

What should a patient do if his scan reports suggest teeth infection, polyps, osteomyelitis, and infection in the implant?

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The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

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Published At October 11, 2022
Reviewed AtOctober 11, 2023

Patient's Query

Hello doctor,

I had systemic inflammation due to RCT (Root Canal Treatment) failure in one of the teeth in the upper right part of my mouth next to my implant. My CRP (C Reactive Protein) was 100 mg/L, and I have been prescribed Clindamycin. I had undergone an extraction of the same tooth, and a bone graft was done as there was an abscess on the tooth. After this, the CRP dropped to 2 mg/L, and the systemic inflammation subsided. However, after a month, I started having systemic inflammation, and my CRP went back up to 200 mg/L. The doctors think the inflammation might come from the teeth based on the CT (Computed Tomography) scans. I also have a fever at night, along with a sore throat and nasal discharge. Please answer the following questions. Did you see any infected teeth in my scan? What is your opinion on the polyps mentioned in the scan reports? Do I have any infection in the bones or osteomyelitis? Is there any infection in the upper right implant?

Hello,

Welcome back to icliniq.com.

I will be answering your query shortly .

Patient's Query

Thank you doctor for the reply,

Please let me know if you have any questions or need further information about my condition.

Hello, Welcome back to icliniq.com.

It is a common finding in osteomyelitis, so you report all these symptoms like fever, sore throat, nasal discharge, or tooth pain. According to the report enclosed (attachments removed to protect the patient's identity), there are alveolar sinus polyps, which means you continue taking the medications as suggested by the physician. You are prone to a recurrent dental infection due to the sinus polyp. I have seen the dental OPG (orthopantomogram) as well. The teeth do not look infected currently, but you are at high risk. So you will need a clinical opinion from a maxillofacial surgeon as I feel your teeth are fine except for some generalized bone loss. These inflammatory alveolar polyps should be treated preferably by ESS (endoscopic sinus surgery). There will be varying approaches to that, so you can get the treatment done by an expert maxillofacial surgeon in the clinic and have an excellent prognosis. If the surgeon feels that you do not need ESS to get rid of these polyps, then you will be again advised of similar antibiotic therapies, just like Metronidazole for systemic inflammation. So do not worry, as there are two ways to treat the polyps: complete ESS and antibiotic therapy. The teeth or jaws do not look grossly infected, but you need a clinical opinion on how to get rid of the alveolar polyps. So I suggest you visit the oral surgeon soon. The prognosis is also good. It is not necessary that the polyps always need to be surgically removed, but if they are large, then antibiotic therapy will not work continuously. High CRP (C-reactive proteins) and inflammation can also be due to dental causes. Is the dental implant shaking?

Patient's Query

Thank you doctor for the reply,

The dental implant is slightly sore. It also looks like the tip of the implant is in the sinus. Is this normal? How would I investigate an issue with the implant? Can you identify where the generalized bone loss is? Moreover, my endodontist spotted the following issues in the CT scan and X-ray. The upper molar behind the implant is infected and drains into the maxillary sinus. The root canal-treated tooth is infected because they missed treating the mesiobuccal root completely. The mucositis or polyp in the sinus is related to the infection in the dental cavity. The bone loss around the root tip and into the sinus is related to the root infection and should heal with good retreatment and possibly surgical curettage. There is also infection on the bicuspid tooth in front of the implant on the same side. The dentist also suspects the presence of neuralgia-induced cavitational osteonecrosis. There is an abscess in the lower left tooth.

Hello, Welcome back to icliniq.com.

I do not feel that the implants or the root canals have any iatrogenic error. The root canals in both segments have been done correctly. It is common for the implants to dip lightly onto the sinus floor. I think that one of the canals looks overfilled, but it might be a radiographic error. Also, the alveolar fossa polyp mentioned in the report (attachment removed to protect the patient's identity) would be more common due to maxillary sinus infection around the dental implants because you might be suffering from osteomyelitis or high CRP (C-reactive proteins). I suggest you continue taking the tablet Metronidazole and ask the physician about the impact of the systemic inflammation on the jaw. You can also consult an oral and maxillofacial surgeon. Yes, the canine looks infected. Curettage can help, but you need a clinical examination and opinion from an oral and maxillofacial surgeon. The probability of secondary infection in the jaw seems more common as a reason for your jaw infection rather than neuralgia-induced osteonecrosis. The lower left tooth filling is close to the root canal. So the filling is close to the nerve, and you might need a root canal for the lower last molar to get rid of it. I suggest you visit the maxillofacial surgeon without delay as they can give you a better opinion. You need treatment for the sinus polyps. If you have further queries, you can ask any time.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Achanta Krishna Swaroop
Dr. Achanta Krishna Swaroop

Dentistry

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