Hello guys, need advice regarding next steps.
A patient had an implant placed by another dentist close to a year ago. Patient went to China and is back for the final restoration.
Upon exam patient has inflammation on the buccal of implant with pus coming from the sulcus upon pressure. I rinsed with CHX and gave two prescriptions of amoxicillin and CHX for one week and scheduled a general cleaning for now. Probing depths today were Mb 7, B 9, DB 6, ML 8, L 6, DL 6.
This was an immediate implant with osteoss-powder : 0.5 cc bone graft, 4.5 x 12mm implant, initial torque of >50N.cm, advanced PRF at time of surgery.
On my examination patient has a lot of attrition, possible grider.
Should I proceed with the final implant crown? I am concerned regarding the deep probing depths. Perhaps they will subside with a cleaning and prescirptions.
by Ilia Oukhalov at Wed, Jul 26, 2017 3:54 PM
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Ho-Young Chung Replied at Mon, Sep 25, 2017 2:17 PM
Dr. Kwon mentioned doing an open flap and looking for a fracture. I wouldn't do this unless you are ready to remove and replace an implant. Crack on implant is almost always mid buccal and it will show up normally on a PA (but not always).
Illia, did you end up consulting with the doctor who placed this implant? did the patient go see him or her? Please keep us updated.
If you want someone else to restore it, send it to Dr. Kwon or Dr. Jin! they love headache cases! lol. j/k remember, last person to touch this case, owns it for life.
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Mark Kwon Replied at Thu, Aug 10, 2017 11:13 PM
please rule out fracture!!!
had too many 3.5 diameter fracture on me.
1. Remove temp crown and see if any damages occur on temp crowns
2 chk for sign of fracture line. Hard to see through bleeding gum unless you have microscope
3. Irrigate well and Place healing abutment and give pt essix/ flippers/ bonded maryland
4 chk in 2 weeks and see if exudate still persist. If it does, proceed with open flap and look for fracture !
5 if tissue has no infection, healthy tissue, go head and fabricate cadcam properly contoured screw retained final crown.
and yes, better for someone else to restore this one! Lol
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Ho-Young Chung Replied at Wed, Jul 26, 2017 4:52 PM
I have a feeling you meant 3.5 by 13 implant and not 4.5 by 12mm implant.
Fixture placement looks good on PA and so do the bone levels. I would discuss the case with whoever placed the implant and have them see the patient again if need be (I'm assuming they have seen the patient already, have given you the go-ahead to restore, and have sent you a report).
Probing depths give you no information about this case other than that it was placed deeply as it should have been. In my opinion, probing depths serve really no purpose for any fixture for even ailing or failing implants. Others will disagree.
It's a beautiful implant and a beautiful temporary crown. There are several reasons for having exudate coming from the buccal but only one of them is normally related to the fixture and the rest are related to the temporary crown. I would not go ahead and restore this fixture until you know the reason and I would hope that whoever placed the fixture will have some answers for you.
With a custom impression coping, you can get a very nice aesthetic result. You will have to be very careful with occlusion as he has had very heavy function on his lower incisors.
I would personally have the person who placed the fixture restore this implant as it is a challenging case both surgically and aesthetically. I can see many things going well but many things could go wrong as well. Just my two cents.