[Surgery]  failing implant?

Scan was done in July 2011 to plan replacing failing LR bridge

NP x13mm implant placed in December 2011

In Jan. 2012, there is evidence of bone loss around implant and soft tissue swelling.

Is there anything can be done to prevent losing the implant?

The prognosis for #4.7 is guarded. Any tx plans?

by Majid Sherkat at Mon, Feb 13, 2012 1:51 AM

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Mark Kwon Replied at Wed, Feb 15, 2012 6:33 PM

If the fixture was engaged with good stability, I would recommend go and change the cover screw to healing abutment which will protrude above the gum. This will allow the patient to keep the area clean. Most likely the purulence is due to thinning out of overlying tissue above the cover screw which is causing oral-subperio communication and it may be very difficult for the body to keep clean.

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Bernard Jin Replied at Mon, Feb 13, 2012 8:20 PM

Good to hear good stability. Don't recommend surgical intervention this early in the healing - hard tissue has begun to turn over and soft tissue is likely very friable. Surgery at this point can be challenging/ difficult to manage. The radiograph shows what appears to be a body's reactive response - to either typical osseous turn over or to an insult (like overheating or bacterial presence). Looks to me like you have a healing abutment on. Seeing the top of the healing abutment should not be a problem. Consider unscrewing the healing abutment, irrigating the soft tissue site, then replacing it with either a NEW cover screw or healing abutment.

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Majid Sherkat Replied at Mon, Feb 13, 2012 7:08 PM

Primary stability was achieved. Tightened to 30Ncm. Soft tissue is inflamed with some tenderness upon palpation. Been on oral Abx and still on CHX as gingivae opening on top of cover screw. What about surgical intervention? or even grafting?

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Bernard Jin Replied at Mon, Feb 13, 2012 4:45 AM

Hi Majid. Thanks for the info. The threads that were exposed - i figure you meant that the threads were completely not countersunk DURING the implant placement. Usually - if that occurs - it's usually only on one side of the implant (usually due to the slope of the ridge). If it's only the microthreads (at the collar of the implant interface) - soft tissue will usually adhere to it if you were able to achieve primary closure of the soft tissue. Your patient - their complaint of tenderness - do you think their complaint is valid? typically - after 6 weeks of healing - they should not be in any pain or discomfort. I suspect soft tissue infection of sorts. Did you perform any grafting around the threads at the time of the placement? Are any of the threads (or microthreads) exposed now? Were you able to achieve primary stability? The soft tissue - does it look highly inflamed ('angry looking')? If so - it may be a sign of infection. Kinda like pericoronitis on top of a wisdom tooth. If you were able to achieve primary stability - perhaps consider replacing the cover screw with a healing abutment under local anesthesia. That would also give the site a chance to vent. Also - consider placing the patient on systemic ABX and topical CHX. If you did not achieve primary stability - consider opening the site up for the purpose of replacing the cover screw and perhaps irrigating the site with sterile saline. Again ABX & CHX would not be a bad idea. If you are already seeing threads (as in threads visible now) - consider aborting the tx. Explantation and retreatment (either at the same or another appointment at a later date). Hope these ideas help!

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Majid Sherkat Replied at Mon, Feb 13, 2012 4:02 AM

No pictures, no mobility, patient having tenderness upon palpation, non-smoker Surgery was uneventful except for some threads exposed buccally. - can check CT scan for the suspicious radiolucency. Implant was placed dec. 8th; last x-ray was Jan. 20th.

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Bernard Jin Replied at Mon, Feb 13, 2012 3:19 AM

Hi Majid, Thanks for your post. Do you have any photos of the site? Is there purulence and/or mobility around the implant? If you have a RFA machine (ostell) - do you have the ISQ reading? Is the patient complaining of any pain/discomfort? Is the patient a smoker? Do you recall how the surgery went? All these questions may assist in formulating an answer to your question. It may also help us formulate an approach to the management of the implant site. If no purulence, no pain, no signs of inflammation, what you may be seeing is simply remodelling of the crestal bone - it may be self limiting an possibly just a transitional thing. What date in Dec was the implant placed? When was the last film taken (what date)? I need more information please. As for tooth 4.7 - should I be assuming it is the one without the clinical crown present? Or is it the one with the amalgam restoration? Please provide more information. There is a substantial radiolucency adjacent distal to the implant mid root. It is suspicious. More information is needed on the 4.7 please. A photograph would be most useful. Thanks.