Immediate Dental Implant followed by cyst removal and bone graft

A 29 year old patient from Assam, India came to our Dental Hospital seeking solution for his painful mobile upper front teeth. Patient gives a history of root canal treatment done for his upper anterior teeth in a single appointment done elsewhere. However the patient had his teeth re-treated twice after the earlier root filling had been unsuccessful.

But over a period of time, the patient experienced pain and swelling with pus formation in the related teeth. To provide relief for the patient, doctor’s elsewhere have performed an Apicectomy (removal of root apex of a teeth along with the infected lesion to prevent further infection).

That did not stop the teeth from getting infected again. Patient continued to suffer with pain and discomfort. Dejected by unsuccessful procedures performed by doctor’s elsewhere, patient ended up in Chennai to our hospital seeking for a permanent solution.

On clinical examination the upper anterior teeth were mobile and patient experienced pain on palpation. The gums surrounding the related teeth were swollen with accumulation of pus. A sinus tracing was done with a gutta percha to find the source of infection.

A full mouth x-ray (OPG) taken revealed a well-defined radiolucency at the tip of the upper front teeth indicating a periapical cyst. A thorough blood investigation revealed no underlying systemic disease

After thorough examination of the patient, Maxillofacial Surgeon and Implantologist, Dr. SM Balaji, planned to completely remove the cyst by extracting the infected teeth under general anesthesia. Followed by the healing period, Dental implant placement under local anesthesia was planned. The patient was explained about the surgical procedure and consent was obtained.

Before the surgical procedure, preparation of the patient was done. Once the patient was anesthetized, Dr.S.M.Balaji, extracted the infected upper front teeth along with the cyst without damaging the supporting structures. The remnants of the cyst were then scooped out completely, ensuring no recurrent cyst formation at that site in the future. The gingival tissue is then stitched with dissolvable suture.

The surgery was a success. Patient did not report any discomfort except for moderate swelling 3 days after the surgical procedure. The patient was put on antibiotic treatment for a period of 5 days. The patient had to wait 3-4months for the bone at that site to regenerate and heal completely. Until then, a removable prosthesis was given to replace the missing teeth.

Once integration of the bone was achieved and no traces of the recurrent cyst was ensured,  Dr. SM Balaji, skillfully placed the Dental Implants in relation to 21 & 22 under local anesthesia. Patient had to wait for a healing period of 3 months for the implant to osseointegrate with the jaw bone. Patient continued on with the removable prosthesis.

Post operative OPG showed dental implants positioned with stability and in integration with the jaw bone. The patient was given a fixed ceramic prosthesis over the implant. It gave a natural well blended appearance. Patient was very happy to have had a permanent solution. It boosted his look and confidence. Patient has been on regular follow up for over 2 years.