[Surgery]  36 buccal swelling after loading

Hi All,

This is a followup from an initial posting named "36 buccal defect". pre-op radiographs are there.

I placed this implant on November 21. Everything was going well until after I loaded the implant. 

I placed a Hiossen ETIII Ø5.0X11.5mm implant fixture placed. countersunk 1-2mm andTorqued 50N

Healing abutment Ø6 X 4H. biooss + Collagen membrane on the buccal to cover a small defect showing 2 threads within the bony envelope Suture with Cytoplast PTRF. PA taken. 

Three month later everything looks good. Although I saw some bone loss on the  PA the gingiva looked very healthy. 

I loaded the implant in March 7 and followed up on March 13 and everything looks great. No pain or discomfort. Gingiva looks nice and healthy. Occlusion good.

Patient calls me back the very next day after followup complaining of sudden pain and swelling in the buccal. I checked the buccal and there you have it!!!!  tenderness, swelling, Bleeding, and deep localized pocket but no suppuration. I can feel the first thread of the implant on the buccal with my probe. I have put the patient on CHX mouthrinse and amoxyl for a week and will followup next week again. 

Any recommendation on how to prevent further boneloss. Should I unscrew the crown raise the flap, and do another bone graft/cover screw?. and try again in a few month or is this implant doomed?!!?

You advice is highly appreciated.



by Keyhan Alavian at Tue, Mar 14, 2017 6:25 PM

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Mark Kwon Replied at Fri, Mar 17, 2017 10:22 PM


I would recommend: process of elimination algorithm  

1  re move crown n healing abut and assess

2  if problem persist then you know it is not the fit  then proceed to "flap exploration" and use i brush (surgical smart) to dethread the expised thrrads and look for fracture line

3   If no fracture, perform prf+ cancellous GBR + CTG might be necessary 

4  if fraxture noted, explant using neobiotech universal fixture removal tool (surgical smart) and replant a new fixture  

hope this helps,

- mark

Likes : 2

Bernard Jin Replied at Wed, Mar 15, 2017 1:18 PM

At first, I suspected there might be a poor fit between the abutment and the fixture.  But as I read your description again, I'm beginning to suspect the problem to be on the outside of the fixture.

The bone loss should be an indicator that something's up.  I suspect the bioss didn't quite take.  For that to happen, I anticipate some sort of low grade infection may have been present on the implant surface (thus your success at finding the first thread) to begin with.  I would recommend at this point performing flapping, surface reconditioning, (possible GBR) and most definitely CTG, before engaging in any attempt to restore it.  Dr. Kwon covers this very well in his implant failures & complications workshop.  Hope this helps.

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Keyhan Alavian Replied at Wed, Mar 15, 2017 9:34 AM

Scrc from Skycad. Screw retained.

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Bernard Jin Replied at Wed, Mar 15, 2017 9:15 AM

Hi Keyhan - the lab which you are using... do they perform CAD-CAM restorations?

Was this a Cast implant restoration or a CAD-CAM milled one?

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Edward Zhang Replied at Tue, Mar 14, 2017 9:05 PM

I will try to remove the Cr. Cleaning up the area and changing back to the healing abutment first.

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Edward Zhang Replied at Tue, Mar 14, 2017 8:57 PM