Dr. B. asks:
I placed an implant fixture #5 area [maxillary right first premolar] and have not had any problems until recently. I noticed a sinus tract on the mid-buccal of the implant fixture. A radiograph revealed a small amount of bone loss on the mesial. I plant to lay a full thickness flap and to debride the mesial and any other area that has granulation tissue. I am assuming at this point that any tissue around the implant fixture that is not osseointegrated is either fibrous or granulation tissue. After debriding the bone, I plant to treat the implant surface with citric acid. I would then place a Puros cancellous particulate allograft graft [Zimmer] around the implant and filling the defect. I would then cover the graft with a Biomend resorbable membrane [Zimmer]. How does this treatment plan sound to you? Any further recommendations?
Bone Loss on the Mesial: Proper Treatment Plan?
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Sounds perfect! In my case instead of citric acid I used Tetracycline and it worked remarkably. I am not suggesting that one is better than other. I don’t know any one whop sells medical grade Citric Acid that too in small quantities!
It works but you need plenty of patience.
By the way when I tried to fix the matter with Allograft the graft got infected. Then I used a bovine mineralized bone and it seemed to work.
I am not expert enough to guess why it failed the first time I guess the zone tolerates deproteinized better than dimineralized. Can some one answer that?
I think even TCP should serve the purpose.
Sounds OK – Good Luck
Once the implant surface is infected it will be lost, it is a matter of time. It might be best to remove the implant, rebuild the bone and place another implant. Cut your losses.
Sounds good. It may be better if you can also scrape some autogenous bone around the area and place it on the implant as the first bone layer. Then follow with the cancellous allograft, and finally the cortical one. But treat it as a first attempt. If it fails, you may have to take the implant out and completely rebuild the bone later.
We have a number of cases like this over the last 5 years with total sucess , we use a prophy jet ( Lang May 09) to clean the implant surface then graft with a Caso4 and BTcP mixture with a negative charge ( see paper R. Smeets etal , A new biphasic osteoinductive calcium cmposite material in Head face med June 09 ) and had no issues.
Peter
just be a little careful with the prophy jet…..
Who needs a problem with using compressed air with an open flap
I got same problem. I Perfomesd immdiate extraction #13 and implant placement. Implant integrated well. Two year post op moderate bone lost at distal of 13 mesial of 14. If I raise flap how can I reconditionning the surface of implant fixture?
Some literature suggest use laser. I have sofe tissue laser is it going to work?
Thanks
Eric Huang,DDS