LANAP surgery vs. Bone graft surgery for 7-8 mm pocket behind #18

[Danni M.]

Hello,
I have a 7-8 mm pocket behind molar #18. By way of background, I had an impacted wisdom tooth removed from the area many years ago. A small part of my jaw was apparantly removed as well. Two years ago, I was told I had a small cavity in this area, and an amalgam filling was placed. I recently had the filling replaced due to recurrent decay. I was also told of the existence of the pocket. I had a deep cleaning of the tooth done, and visited a periodontist.

The periodontist presented me with two options. The first was surgery where they would remove a small portion of the gum, place bone in the site and suture the area. The cost was $2800. The second was described as laser surgery, similar to LANAP, where the laser would, hopefully, stimulate bone and tissue growth. The cost of this is $1500. The periodontist said if, for some reason, the laser surgery didn't work, he would apply the cost towards the bone grafting surgery. He also said he thought both procedures were likely to be successful, although they have only been doing the laser surgery there for six months.

Given all that he said, my strong preference would be for the laser. I did want to see if there was anyone who was familiar with both procedures, though, who could give me some further insight.

I'm attaching my most recent x-ray of the tooth, in case this helps.

Thanks very much

 

[Dr M]

Laser surgery is my preference, since the procedure in itself is painless. The only downside in my opinion, is that bone growth is not always guaranteed. It is nice that the periodontist is willing to count the cost of the laser. towards the cost of the alternative surgery.

 

[Danni M.]

Thank you very much for your reply, Dr. M. Initially, I was very much on board with the laser procedure. However, upon doing some research, it seemed as though a lot of people were disappointed with the results and also felt their bites were distorted with subsequent necessary adjustments. I was concerned to hear that the periodontist also intended to file my adjacent tooth, so that the laser would not hit it. The bone and tissue graft, on the other hand, seemed like a very serious procedure with a long recovery time, and I wasn't prepared to undertake it, at this point.

I was surprised that surgery was recommended for me at all. At my last dentist visit on 1-31, I was told that the pocket was 6-7 mm, and that a deep cleaning, proper home care, and possibly the application of Arestin was all that was needed. Since that time, I've been diligent with tending to the area, and the persistent bad taste which bothered me for months, has all but disappeared. I went to the periodontist because I wanted to have another doctor check the area and see if there was anything else, like the Arestin, that could be done to get me to 100%.

At this time, I'm keeping up with my home care, and my plan is to see another dentist in the near future for a second opinion. My hope is that the pocket will shrink, and that other options will be available.

In your opinion, Dr. M., is this a prudent course, and are there any less aggressive, non-surgical options you would recommend trying before either the laser or bone graft?

Thanks very much for your time and expertise.

 

[Dr M]

You can delay treatment for now, and have your dentist measure the pocket depth with your usual check up visits. It will be important that you go every 6 months, without fail

 

[Danni M.]

Thank you again for your reply, Dr. M. You've put my mind somewhat at ease. I will do as you suggested, and stay on top of my check ups and keep up with my home care as well.

 

[Danni M.]

Several weeks ago, I went to a periodontist for a second opinion regarding my gum pocket. This doctor has excellent reviews and forty years of experience. So, when he recommended osseous surgery plus a bone graft, I decided to go forward.

I had the procedure done on April 9, and initially all went well. Nine days later, I went in for my follow up appointment, and the doctor said I was healing well. He told me to start brushing my tooth and gumline, and that in doing so, I would dislodge the two dissolvable stitches I had. He said there might be some bleeding, but not to worry.

Two days later, one stitch came out without me even knowing. With the other stitch, though, I felt a definite pinch as it was dislodged. While it didn't bleed, later on, I had a strong taste of blood and also felt like I had a cut in my mouth.

I called the office when they reopened on Monday, and the doctor had me come in that day. He said the area was fine, to continue brushing it twice a day, and that I needed to give my body more time to heal.

It's been eight days since I saw him, and ten days since my stitches came out. I no longer taste blood nor do I feel like I have a cut in my mouth. What's bothering me, though, is that for the last few days, I have the same bad taste in my mouth as I had before the surgery, except it's worse. It's particularly noticeable when I rinse my mouth out with plain water.

I'm wondering if this is caused by inflammation or something else? I appreciate that the doctor said the area is healing well, but this is very annoying. My next, and final, appointment is scheduled for May 9. Is there anything else I should be doing to aid in the healing? How long might this last?

If anyone has any advice, I would greatly appreciate it. Thanks very much.