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Graft Has Resorbed: How To Handle?

posted in Bone Grafting

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Anon. asks:

I was preparing for second stage surgery on implant #3. I noticed that 3 superior threads were exposed, but the dental implant was very stable. Not mobile and tissue not inflamed. I placed this implant 3.5 months ago and used a Puros graft and covered this with a BioMed membrane. Now it looks as though the graft has resorbed. How do I handle the situation now? Bone graft again? How do I treat the implant surface? What happened?

6 Responses to “ Graft Has Resorbed: How To Handle? ”

• Dr. B November 19th, 2007

  
  

  i am affraid you have to remove the fixture and put it deeper. vertical augmentation is highly unpredictable.

• JOnathan Abenaim November 20th, 2007

  
  

  remove it???

  Ok lets first get the facts where is it located?
  How long is it?
  Is it fully integrated?
  Is it an esthetic concern?
  what type of implant?
  was in an immediate placement?
  what is the tissue biotype?

  I can go on and on please list the facts and xrays so that we can be of assistance.

  Removing implants just because someone lost a couple of millimeters is definitely not indicated?

• jeff November 20th, 2007

  
  

  What type of implant did you place? was it a tissue level supported implant or bone level supported implant?

• Dr. B November 21st, 2007

  
  

  3 threads exposed after 3 months time, the prognosis is poor. there will be perio problem sooner or later

• Dr. JB November 21st, 2007

  
  

  I agree with DR. B…There are definitely going to be problems in the future, and it might not happen in the next year however go ahead and expect future problems.

  I assume you did an immediate placement. I know immediate placement has been a success with some DRs, however it is still very very unpredictable….as you have found out!

  First of all Puros is an osteoconductive material…not to say it isn’t a good graft material, but it is not a good bone regeneration material as it favors osteoclastic activity because it doesn’t react as fast as a low calcium content material that will favor osteoblastic activity. I don’t know much about the BioMed, however the biggest question is how did you place the implant? Did you extract and then clean out the site wo get rid out all the fibrous tissue….then place the graft material in the socket without a flap? If you did this there could be one major thing wrong that you wouldn’t have gotten to see without a flap. There could have been a biological defect (a possible hole) on the facial that was introducing periodontal pathogens to the graft that would create osteoclastic activity.

  So many questions need to be answered before you can learn from this mishap, however don’t get discouraged….use this as a stepping stone to improve your skills. I can attest that we have all been there.

  Please provide th following info:

  Immediate placement?
  Clean out all the fibrous tissue from socket before placing graft?
  Lay a flap?
  How did you cover your graft with the membrane? (Cut a hole in the membrane to fit over the implant or place the membrane around the implant on both sides without cutting the membrane) Please describe in detail.
  What implant system?
  How long did you wait?
  Was it loaded at all (temporary or tissue contour abutment?)
  What # were you replacing?

  With these answers we can better assist, however we don’t know the full history of the patient and we can’t see their file to fully diagnosis. However we can give you more info to at least better yourself for this case and future cases.

• prof.Dr.Dr.Hossam Barghash December 19th, 2007

  
  

  as you said it sound like the graft is resorbed,& i think you the only one can tell, cos you know the situation during the first stage of insertion, now we have an integrated implant with threads exposure with no inflammation, so what you can do is to retreat the surface of the implant with citric acid& do mild curretage to the bone surface ,do bone grfating& keep the implant unloaded,keppeing in min all precaution for graft success

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