[Surgery]  Incision line opening

by Christina Yee Min Wong at Fri, Jul 1, 2011 10:20 PM

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Mark Kwon Replied at Fri, Jul 8, 2011 1:06 AM

Hi, Christina. Thank you for the post. I do remember the case with insufficient bone height. difficult case. I do agree with you that bone loss is present. however, im not sure if the bone loss will continue. Any sign of infection? exuddate? The bone loss may be due to over load of the specific implant. some times when you cement bridge or screw retain multi span bridge work, inadvertently, one implant may receive more load than the other implants. And bone loss on that implant will continue until the stress is diminished. In these cases, oftentime, bone loss is self limiting. In regards to removal of middle implant : that is not a bad idea, however, even if the short implant has bone loss as we see on x ray, it may not be as easy as you think when you actually go in there to remove the implant. Have to weigh pros vs cons. In my office, if there is no sign of further bone loss, no sign of infection and tissue is stable, I may choose to monitor little longer. In case of implant removal, I may try to adjust the existing bridge and convert into 3 unit implant supported bridge if possible, to keep the cost down for patient. - mark

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Christina Yee Min Wong Replied at Tue, Jul 5, 2011 2:30 PM

Dear Dr Jin, Thank you so much for the input. I will be seeing the patient in a few hours.Will keep you posted on the development of this case. Your advice is very much appreciated. Christina

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Bernard Jin Replied at Sun, Jul 3, 2011 7:27 PM

Hi Christina Thanks for posting. This is one of those cases that PRF would probably help. If I were to attribute a cause to the opening of the graft site - it's probably a result of flap design and closure. Regardless, your options are relatively limited now. If you are familiar with PRF, you could perform repeated PRF treatments on the site to facilitate soft tissue closure. Keeping the PRF there on the site will be challenging since it is adjacent to much muscle movement (site does not have 'protection' by static structures like adjacent teeth, etc.) Re-suturing the site is certainly difficult - since often the flaps become thinned out and friable. Often, with the graft - it doesn't hurt to reinforce the graft with soft tissue CTG. If you ever decide to suture the graft site again - consider performing a CTG as well for added protection. Exposed CTG is usually not a problem - if the flap opens up. You did the right thing - reducing the allogenic block graft so as to facilitate soft tissue healing. Naturally, in the event of an opened and exposed block graft - I would recommend CHX rinses (at least tid) and possibly ABX until you achieve soft tissue coverage. Hopefully, you will get closure via secondary intention. Just a few of my thoughts - hope that helps. Bernard

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Christina Yee Min Wong Replied at Fri, Jul 1, 2011 10:41 PM

Hello,all, This is the first time I posted at this forum. The first picture was taken three weeks post-op . The surgery done was a allogenic block graft in QIII. The incision line was found open three weeks post-op . I have tried to open the flap and trim the exposed bone and then re-sutured the site. It was very difficult to re-suture as the tisssue was very fragile. The second procedure had made the situation worse. There is now a larger area of bone exposure and I am now lost. I do not know what to do! Can anyone give me some advice ?