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Purulent Discharge on the Mesial and Distal: What is Going On?

posted in Bone Grafting, Wide Platform Implants

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Dr. Y. asks:

I extracted #30 [Ed. Mandibular Right First Molar] and placed a bone graft and covered it with a membrane. After 4 months the bone graft had a radiographic appearance comparable to the surrounding bone so I placed a wide platform dental implant. I restored it with a PFM.

The patient returned this week for a 3 month post-op and I found purulent discharge on the mesial and distal. Radiographically the bone at the graft site looked less dense than when I originally placed the implant. What is going on and what can I do?

7 Responses to “ Purulent Discharge on the Mesial and Distal: What is Going On? ”

• dr.amit narang August 22nd, 2007

  
  

  purulent discharge suggests that infection is there, n leaving it is gonna make it worse, you’ll have to
  * open the flap currette the area,
  * check for cement overhang under the PFM,
  * graft the site if substantial crestal bone loss is there,
  * and may be remove the abutment n wait for the infection to heal before re-attaching the abutment.

• Don Callan August 22nd, 2007

  
  

  The graft material that you used may not have been a regenerative material. You should a regeneration material to give living bone result. Most bone gragt materials today are only fillers and do not give a good blood supply. Take the stuff out and redo the procedure with a regenerative material, it will work.

• steve c August 22nd, 2007

  
  

  Don, do you have specific materials you could recommend? Dr.Y wasn’t specific about what “bone graft” material had been used in his augmentation, so I would also like to find out from him what was used and how long he waited before placing the implant.

• Bill Pace DDS August 23rd, 2007

  
  

  Dr Y
  If the bone looked good when the implant was placed,then you had a problem with it after loading, I would suspect with out seeing the case that you might have an occlussion problem.Is the implant mobile at all? Put your finger on the buccal surface and instruct the patient to grind hard in all directions.If you feel movement evaluate it for total occlusal relief,Good Luck
  Bill Pace DDS

• Don Callan August 24th, 2007

  
  

  Steve C,
  The literature says to use a demineralized bone that has been properly process. Dr Roberts, Dr Simmons and Dr Edwards have shown to allow 4 months after the regeneration procedure be implant placement and then allow 3-4 months for the bone to mature. However, Nobel and other non-research people will say implant in a day or an hour???? The question is “What do you want to do in you mouth?”

• John Clark August 27th, 2007

  
  

  Dear Dr Y
  I am a beginner when it comes to implants and bone grafting, however, I have two very experienced mentors who both strongly advise to always leave a grafted socket for 6 months before attempting placement of any implant. Further, with upper anterior labially grafted sites, a flapped look at the 6 month point sometimes indicates leaving the site for another 4 months if the graft does not have a well intergrated appearance. To do otherwise will risk splitting of the graft off the ridge when the implant is placed.
  Regards John

• Dr. Bill Woods September 1st, 2007

  
  

  Was the bone pink when you flapped it for the implant? There are many variables her not being able to see an xray. What speed did you do the osteotomy? How close was the buccal wall? What did it look like on uncovery? 1 or 2 stage? Antibiotics? Sterile technique? Flapless? We need to know a few things. Bill

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