Implant Threads Exposed: How to Handle?

The buccal defect sounds like you over torqued the implant during placement. If you are using a tapered implant that is a noted problem. It is rare to over torque a straight implant although it can be done. When I placed nobel biocare several years ago that would happen to me. I no longer place nobel due to pressure necrosis problems. As for the graft, I do not use that bone graft material. Hope that helps.

It is difficult to guess something. It would be very useful to provide some information such as: 1) Which area of the dentition we talk about; 2) How long time after the tooth extraction was the implant placed; 3) How was the bone condition during implant placement; Any inflammation? Any ubnormal conditions? How thick was the buccal bone after the implant placement? Was the bone dense or "soft"? 4)When this bone loss and tissue recession occured? Was it rapid or a slow process? 5) What type of implant did you use? 6) Did you overtorque the implant? Tricalcium phosphate can be an alternative in such problems. I usually mix it with autogenous bone. The question is, if this bone can be reosseointegrated with the implant (and here comes an important matter: What type of surface the implant has). If your implant has good stability, despite of the bone loss, I would not care if the graft will reosseointegrate, since it will support my soft tissues (in case of having the implant in the aesthetic zone). If my implant was placed in the posterior regions, probably I would not do anything, especially if there were no signs of infection or inflammation. If yes, then I would treat the site with major goal to provide the conditions for good oral hygiene at the exposed threads, apart form treating the infection.

I had the same thing happen with a 3.0 one piece overdenture implant from Biohorizonz. I called my periodontist who places a lot and he said he just takes a diamond and removes the threads that are exposed IF they are in just a small area and polish. I did just that and all seems well.

Hi, thanks for the response. To Periovp's questions. The region was the lower right 2nd premolar and the extraction was 3months before the placement of the implant.The bone was soft as expected. I noticed the exposed threads immediately after placing the implant so the TCP and membrane was placed at the time of implant placement. I would like to know the use of TCP in implant dentistry.(when to use and what cases are conducive for TCP)

Sounds as if there was insufficient crestal buccal bone. Was the socket grafted after the tooth was extracted? Often, I am unable to place immediate implants for this exact reason. Did the tooth fail for periodontal reasons or caries? If it was periodontal, then that explains the loss of crestal bone. Need more information to give a complete answer. Do yourself a favor if you have decided to enter the surgical implant arena. Take a good course on bone grafting (block grafts) 50% of the cases require it. If it is in the esthetic zone of this patient, it will probably be a problem long term. You may consider removing it, grafting the osteotomy and place a new implant at a later date. If it is not an esthetic problem, I would consider removing the threads and doing a connective tissue graft to thicken the tissue. This should resolve the inflamation problem with the threads that are exposed. good luck!

Cut your loss, take the implant out, graft the area, do a wax-up, make a surgical stent and place the implant into living bone with at least 2mm bone on all sides of the implant. Block grafting is not always the answer, look at ALL grafting materials.

Does it help to mention that I have a small dental implant 2.2mm diameter in my patient's lower left canine area used for denture stabilization that has about 3 threads exposed covered with plaque for the last 4 years? I see the patient once a year and it has remained status quo for the last 4 years. I do not intend to do anything as it is stable and helps to stabilize the denture very effectively.

Don Callan is right. If it is "shortly after implantation", take it out now. Its not integrated. If it has been a month or so, you also probably have a good tissue bed over it for 1ry closure. Should go smooth. later it all be more difficult.And since we are on thread exposure, Don, I have two with 3 threads exposed and fully integrated. Fight accident. Patient didnt come in regularly. Football accident. Smoked on the implant surgery. I did a KT graft on the buccal. Looks better and is 3+mm thick. Deciding on the next course of action.Implants still have cover screws and completely buried. What about tenting a membrane over the implants using the cover screws with some autogenous? Bill

Dr. Kfc - Probably doesn't help to mention it because most posters here don't think mini implants are real. Just because they work, don't fail with exposed threads, and can secure both dentures and fixed prosthetics reliably and inexpensivly doesn't matter, according to the FDA they aren't "real" implants. Just keep doing those block grafts, cadaver augmentations, laser repairs, membrane mounds, etc. for ten or twenty more years until minis have been around long enough to be "accepted" by the FDA and God.

Hi, Read and heard a lot about socket preservation by grafting immediately after extraction. How does one graft a socket and close the socket primarily? Even if membrane is placed the membrane would be exposed and would get contaminated and thats not permitted, right? Then how do you graft and close primarily a fresh extraction socket.Does TCP work in such situations?

One may guess that the crestal bone resorption is due to insufficient bone at the buccal plate and/or using an implant from a self-tapping system. Why don’t you treat it like in the case that implant threads are exposed in a peri-implantitis? Skip the decontamination, polishing, acidifying processes and jump to the bone grafting around the threads. I, personally prefer to place a viable tissue like autogenous cancellous bone over the implant threads which are made from a non-vital metal. Over the recent years, much experimentation has been done on signaling molecules such as growth factors to restore lost bone support due to damage to the alveolar process, both of inflammatory or biomechanical origin, so, if you have decided to take advantage of a biomaterial, you should never use them alone. Primary soft tissue closure through a rotated or laterally advanced flap at the time of tooth extraction and delaying implant placement for a few weeks reduces incidence of membrane exposure. Resorbable membranes do not demand a second procedure for their retrieval. However, premature resorption will lead to insufficient bone healing and they are very susceptible to bacterial contamination and infection as well. Lately, certain membranes have been reported to have an enlarged degradation time through collagen cross-linking. Recent studies suggest that cross-linked membranes might remain intact even when prematurely exposed to the oral cavity.

Dear manoj, I agree with Dr. Jafari I dont think it is good idea to remove implant at this stage, as you already have tried to salvage it.And if you have done it properly It should work. How are you going to explain patient that what you have done is not going to work and implant have to be removed.If I were your patient I would loose confidence in your capabilities. As Dr. jafari mentioned I like to use autogenous or puross in this kind of situation with non resorbable membrane. Even if your gaft fails, in cae of mandibular second bicuspid you can polish those exposed threads or do a cementable restoration with crown margins on implant body. I totally disagree with Dale regarding 50% cases requiring BLCK grafts. At NYU we mostly do particulte grafts with great succees. As for your question regarding primary closure of socket, there are different flap procedures to cover sockets,or a FGG or CT grafts can be harvested from palate or tuberoity for soft tissue coverage. Unless it is very large socket like molars, You can just place Collaplug on top of graft and use criss cross sutures.

SJ: How do I explain to a patient that something isnt going to work? I tell them. Of course, I told them prior to surgery that sometimes, things dont work (on the consent).You monitor healing. And if it isnt going well, you say, "it isnt going like I want it to and I want it right. The implant is not going to look right like this and I want to take it out now and redo it later on when everything is better. If we wait, we may still lose it and have a much bigger mess to fool with. So lets do what we have to do now and we will try again when things are healed over." YOU have the contol now while it isnt integrated. Sure it is frustrating, but there isnt a sole here that hasnt had a failure (or wont have one). I think patients understand that their own biology plays a part. The few failures I have had have been dealt with straight up. They were all late surgical failures, but one was most likey an early failure I rode out because the tissue improved quickly and things looked better quickly and I assumed "improved" quickly. NOT. It it turned out to be the worst failure with such horrible bone loss that it precluded reimplantation without a block and KT graft. Patients will respect your judgement MORE to abort early on than to screw around with a late surgical failure. My feeling is that the patient is more likely to lose confidence in you if you DONT take early action and then start dicking around with it until everyone is frustrated. I had (and still have)a great patient for the wreck I rode out, but you may not be as lucky. Be prudent. Dont try to be a hero. JMHO. Bill

Bill I have my own reasons for my opinion. 1, The problem I have here is, I am placing implant and find three threads exposed, tell the patient I am going to take care of it, graft the defect and assure the patient, it should work.Then in few weeks I turn around and tell the patient "No, I was wrong first time. Graft will not work I have to remove implant." Basically I am lying to patient in one of those two statements. I have no problem removing implant right away before attemting graft. 2, If grafting is done properly, it should work, means I am not sure about absolute failure of graft.Then again I am lying to patient suggesting him/her that graft will not work. 3, If I am less experienced clinician I might end up in worse situation then I am in now,if my graft fails: and we know grafting involing membrane does not have 100% success rate,not even in experienced hands. 4, manipulation buccal flap for primary closure in mandibular second bicuspid by less experienced hands may end up in violation of Mental vessels and end up in bigger complications. 5, Finally It is unaesthetic zone and I would take my chances with longer crown with pink porcelain then all those problems in avoiding it. I would inform the patient of probability of that. By the way Manoj, If you are interested I can send you power point presentation about socket grafting procedure. e-mail me sj18@nyu.edu

Do it the Greek way! Graft the area raising the flap until it reaches the neck or a polished part of the implant(i dont know whats ur implant type exactly).Just be cautious not to graft with solely autogenous bone because after 4months ur gonna get a huge bone loss.I personally use Perioglass as graft material.Thats not gonna osseointergrate probably but since u have stability it doesnt need to.Itll just help the hygiene and the aesthetics.gl

periovp: I reread your thread on this. I guess I havent tried to graft threads this early but if it will support the tissues, I may have a case for this. Would like a little more input on your time frame and some surgical specifics. SJ: I hope you didnt think I was being critical of your method, my comment was to describe how I might handle this situation at this point. I come out better with the skill level I practice by deciding to gain a better clinical situation overall and start fresh. I work best that way. Its my comfort/confidence level. I suppose it is like a sinus graft. When it isnt going well, get the stuff out and try again later instead of hammering it with antibiotics and hope for the best. In my hands, Ill do better for the patient this way. Hope that helps. Bill

M, Do not pay attention to negative comments.Implant is stable and exposed threads are grafted immediately.you have done right thing. Peace. pk

We have had success using TCP and Ca sulphate , just raise a flap clean the implant threads with a prophy jet wait for bleeding to slow then graft with the material and ensre it sets. Then get enough relief in the flap to ensure a passive resuturing. We have had some great results as for mixing autogenous I try to avoid that as I have noted better results without it than with.

In the future, I would recommend staying more lingual to avoid the buccal plate from thinning or collapsing.

Ken Clifford, Thanks for your comment. One can hope. Eventually, it will make sense that a smaller breach in the mucosa allows implants to have a greater success rate both immediately and in the long run as the patient goes through different phases in life when the immune system weakens and especially as the patient grows older or suffer some sickness that may diminish their resistance. The advantage of a smaller breach becomes clearer. Especially when it does not compromise the strength of the implant body since they are usually solid alloys. We cannot duplicate the epithelial attachment but we can reduce the critical margin of possible incursion.

sir during my implant placement in rt premolar region 4.3 mm diameter and 16 mm length 2 threads on the buccal side was exposed ihave got a good mucosal coverage ,please advice

I am not an expert on this. This is a good question. I would speculate that a subepitherial ct graft may do the trick, but you would have to release the existing mucosl tissue. I wouls immagine occlusion and tissue thickness and attachment are issues. Just a thought. I welcome any other suggestions from thost that have made it work.