Keystone One-Stage Implant Discovered a Dehiscence: Should I Remove the Implant?

Dr. SC asks:
I placed a Keystone 5.5 x 8mm implant in #19 site [mandibular left first molar; 36] 2 weeks. Upon completion of the installation, I discovered a dehiscence on the lingual side of the implant with one thread exposed. The reason for using short implant was to avoid the inferior alveolar nerve which was located about 10mm from the alveolar crest according to her CBVT scan. There is adequate primary stability.

However, I am worried about the epithelial downgrowth from the lingual side which I am concerned may interfere with the apposition of bone and compromise the osseointegration.

Should I remove the implant right away, bone graft, and delayed another implant placement before any integration occurs, or should I leave it and prep the margin gingivally 3 months from now if it integrates?

4 thoughts on “Keystone One-Stage Implant Discovered a Dehiscence: Should I Remove the Implant?

  1. Dear SC,

    Since it is only 2 weeks since you placed the implant, and there is adequate primary stability…why not try a graft procedure.

    I would recomend using PRP, reflect the tissues well so that when the particulate graft is placed and covered with a membrane, you will get good primary closure.

    For added insurance, wait six months before exposing the implant, which at that time, hopefully will be covered by bone which you will have to cut away to expose the implant.

  2. Why not use PDGF with PRP. When combined with BMP-2, it seems to give the best result. If you cannot afford the BMP-2, then switch with PRF mixed in a 20:1 ratio with PPP and you should see a nice result also. I do this for all my implant cases and have never seen a failure.

  3. Dr SC
    Your best chance for the best outcome is to graft the area at the time of placement if you see less than 1.5 to 2 mm of bone buccal or lingual to the implant.
    Post surgery, your safest route is to make sure you have tension free primary closure of the surgical flap after your grafting, and use mattress sutures for flap closure to avoid a dehiscence of the flap closure. This will require releasing periosteal incisions.
    You want primary closure and the implant buried.
    If the threads have been exposed to the oral cavity during healing, make sure to treat the surface appropiately if you expect bone apposition to it.
    Good luck.

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