Small sinus tract on 3 yr old implant: any input?

Put a gp in the sinus tract to see where it's coming from. Take a paxray with it in.

You are not responsible for costs three years down the line, it looks like you are referring to the midline maxillary suture. Any way it is probably a soft tissue hygiene issue, you could just clean it out when you place the abutment or use some arrestin. I can't tell what you are referring to without a photo, the film seems fine. The gutta percha is an excellent idea since I don't see the fistula. Is there any pocketing? Be very gentle with a plastic probe you cant strip the attchment. Good luck

The other doctors gave you good advice. There is no reason for you not to treat this case, if needed. If you place implants, then you should be able to manage the rare complications. Worst case with this one, is to flap, due ride/saucerize, detox and close. It will be ok. I tell my patients at the initial consultation that with dental implants their level of responsibility has increased and that the maintance on their part is more demanding.

I must assume that there is still soft tissue covering the implant. If the implant was placed several years ago and the patient has been wearing a transitional appliance, is there contact between the denture and soft tissue? If so, there is probably a microtrauma induced inflammatory reaction, especially at the facial line angle of the implant if the bone has resorbed. If this is the case, first relieve the appliance. Use an antimicrobial for a few weeks and see where it goes. If there is still exudate, then the site should be opened and debrided. Also look for the presence of residual bone spicules from the graft procedure. This will produce the same response. RJM

Place the thinnest GP in the tract and take a pa. Could be an adjacent tooth. The central ?

As mentioned above, all the advice given is the truth, and spoken by experienced implantologists. After an implant is placed, and the soft tissue is allowed to heal uneventfully, and the implant is totally submerged.....prior to uncovering, infiltrate with a local anaesthetic buccal and lingual ( or palatal) , and almost always a jet of the anaesthetic will come spurting out a tiny orifice you did not know existed ....its as if the implant wanted to have a "breathing tube". Why do dentists have to have a feeling of guilt if something does not seem perfect? Nature sometimes acts in strange and unpredictable ways, which we can not always control...we just have to know the shortcomings and try to solve the problems.... and should not be expected to be perfect at all times.......physicians are not perfect, they cannot fix every problem...... this is why funeral chapels exist! Dr. Gerry Rudick MOntreal

The sinus tract may be from a loose cover screw. At times, this works loose and bacteria gets into the implant body. I have seen these fistulas generally from the implant/abutment/cover screw interface. All you may need to do is uncover the implant and tighten the cover screw or place a healing abutment and get on with the restoration

Well said Gerald things happen out of our control , we learn from them and dealing with issues becomes the interesting part of Implant Dentistry. Peter

Was the crown cemented on? It is possible you have excess cement that is causing this drainage. You might flap the area and see if there is cement extruded beyond the crown margin.

Suggestion to take IOPA with GP is very good to know the source, but it may not be final answer .If suggested modalities do not give result then its possible to have CBCT , can be good diagnostic tool. I did not understand when its written " in attached gingiva " . One will have to be careful not to have gingival recession after flap surgery as advised by few. If GP does not find any sinus track , it may be non attached graft bony spicule, When it drains out , it will heal. I will be good idea to post after results of these queries ,

You gotta have an in house CT scan. Primary closure over implants is very often accompanied with fistula like the one mentioned in this case. If you say 3 yrs and then fistula with it, then it is loose screw or food in the hex of cover screw. The fistula would have cause some bone loss of the facial crestal bone. That's why I hate primary closures. In this case after the implant placement, the temporary crown should have been placed and if needed some sectg from tubrosity, hugging g the temporary crown. And a flipper or Essex ......none of that. The temporary has to arise from the fixture. Provide px with good quality of life by putting a temp crown....especially in the front. Cosmetics is excellent, no uncovery surgery, no fistulas, and progressive loading. Well in this case uncover the implant right away, clean and scrub with IV metro / clinda soaked gauge, make a nice screw retained temp and to avoid the nightmare of recession, place a thick sectg from the tuberosity and let it mature for 6 months. Remember sectg at the uncovery stage is paramount. CT scan evaluation is must to have a feel of the buccal bone level and thickness. Sam Jain Center for Implant Dentistry Fremont, CA www.bayareaimplantdentistry.com