[Surgery]  Purulence

Hello everybody.

I placed this immediate implant without complication in mid June.

Today or at the 3 month mark I was going to utilize a tissue punch to access the implant. When I anesthetized the crestal gingiva I noticed some minor purulence. Prior to anesthetizing everything looked great and I was surprised. I then used a 4mm tissue punch and ISQ shows 92. Radiograph on left is at placement, then next 2 are from today. I also remember at a 8 day post op check for a 46 non immediate implant in healed bone I had some purulence as I always palpate the surgical site by habit. I flapped the area and debrided and this implant is okay. Is this phenomenon related to some foreign body from surgery or am I missing something. I always flush the area with saline before suturing all cases.

Dr. Chad Denomme

by Chad Denomme at Wed, Sep 7, 2016 10:29 PM

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Chad Denomme Replied at Fri, Sep 9, 2016 4:36 PM

Hi Mark with the immediate how far subcrestal from the buccal plate do you like to place your immediates. In this case I was 3-4mm so I think the flipper was the problem because when I put the healing cap on which was barely above the gingiva I had to adjust the flipper tooth. Any other options other then flipper. I have done a few immediate implant, immediate crowns on laterals and first bi's starting of course with easier cases of course and resorting to fippers in tougher situation like deep bites which dont accomodate immediate crowns as easily as the temp abutments are straight only. Too bad they dont make a 15 and 30 degree temp abutment. The purulence from the 46 must have been because I was not subcrestal enough Thanks again Chad

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Mark Kwon Replied at Fri, Sep 9, 2016 7:06 AM

Two possibilities if this is what you are seeing routinely: 1. Fixture is not buried deep enough : This causes overlying soft tissue to heal too thin, thus leaving very small tiny pin-hole openning through which bacteria can enter and harbour : solution: place fixture slightly more sub-crestal 2. overlying flipper is causing pressure-mediated soft tissue thinning : This is quite common among dentists who prefers to bury their implants and use removable flipper as their main temporary device. solution: relieve the base of the flipper to not exert excessive pressure over the tissue; relieve occlusal contact points to make sure that there's no excessive force on flippers hope this helps, - mark