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Exposure Down to the Second Threads: Recommendations?

Last Updated: Mar 20, 2012

Dr. K. asks:
I am a periodontist and install implants for my referring dentists. Recently I was referred a case where the patient was missing #25, 24 and 23 [mandibular right lateral incisor, mandibular left central incisor and mandibular left lateral incisor; 42,41,32] and the dentist treatment planned for 2 implants to be restored with a fixed partial denture. I placed Ankylos implants in #25 and 23 positions. The referring dentist placed a temporary cement retained fixed partial denture. The patient now presents with a huge excess cement mass that apparently filled the spaces left by the original surgery. The patient has bone loss on both implants with exposure down to the second threads. I curetted the site and sutured close. What do you recommend that I do now? Should I use a particulate bone graft and membrane after disinfecting the threads? Mineralized or demineralized? Allograft or xenograft? Pedicle or some kind of soft tissue flap to close the site? Or should I explants the implants, graft and install new implants later?

5 Comments on Exposure Down to the Second Threads: Recommendations?

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Dr. dan

3/20/2012

Xrays would be nice. However, at this, there is not much that can be done. A lot of the time I see recession on implants in this region of the mouth. Bone grafting won't do bobkus. A Periolase might be able to disinfect the implant surface, but if it is exposed to the oral environment, we know bacteria will just accumulate again. At this point, if the implants are not mobile, disinfect the surfaces and maintain and watch. My last questions is, what does the soft tissue look like around these implants? Is there sufficient attached gingiva or are we dealing with a narrow band or no attached gingiva? If it is the latter, consider, a free gingival or connective tissue graft to increase the zone. Again, bone is useless once an implant surface has collected and colonized bacteria. The surfaces of most implants are super rough.

Periodoc

3/20/2012

Dr. Stu Froum has submitted an article with several case studies showing clinical and radiographic bone fill around implants which had peri-implantitis. He treated the cases using flap surgery and osseous grafting, after meticulous removal of calculus and biofilm. At the last AAP yearly meeting, Dr. Myron Nevins showed a case from Japan, where periimplantitis, with bone loss, was reversed using a flap approach and a laser...not sure of the laser. So, it appears possible in certain, ideal situations which exhibit space making defects and in which access to all exposed surfaces of the implants is possible. We're just at the beginning of this learning curve.

Dr. dan

3/20/2012

Bone fill with a laser, yes. Regeneration, don't know. There are not many histology proving regeneration/reooseointegration around a peri implantitis implant. But, yes, in some cases of ailing and failing implants, bone fill with the use of the laser.

Dr TMoravej

3/25/2012

as you have mentioned , presence of excess cement at the surgical site seems to be the main cause of the bone loss , this is what we call it as cemntitis, just remove the cements, clean that area carefully apply a good amount of large size biooss material , cover it with a membrane,and that is all , you will see the bone regeneration in few weeks

A.Tarek

4/25/2012

use your tapered stone and make threads smooth and try to make space self cleansing. put patient on chlohexiden mouth wash...and watch...bone grafting wont do much for this case

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