Anon. asks:
I had recently placed an implant in the lower mandible region in order to replace the missing lower left central incisor. The surgery was uneventful. Two weeks later, the gingiva started to appear necrotic. It appeared slightly hyperplastic but with no evidence of pus. There was a moderate loss of adhesion to the bone. The implant placed was a two stage implant (3.5×11). Could it be possible that I am dealing with tissue necrosis due to insufficient bone width around the implant? There was about 5mm of space to start with. What should I do now?
Tissue Necrosis Around Implant: What To Do?
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Make sure they’re rinsing (salt water or chlorhexidine) and give it a couple more weeks.
3.5 MM OF IMPLANT IN A SPACE OF 5 MM IS NOT ADVISABLE.. .. THAT LEAVES YOU WITH ONLY 0.75 MM OF SPACE ON MESIAL/DISTAL OF THE IMPLANT, IF AND IF YOU PLACED YOUR IMPLANT IN THE DEAD CENTRE OR ELSE.. .. ONE SIDE YOU HAVE EVEN LESS RESIDUAL BONE.. .. WHICH IS OF OBVIOUS CONCERN & HENCE CAN LEAD TO BONE LOSS.
Expand then place the implant.
If it is a two-stage implant and you had submerged the implant, just expose it as soon as possible, if not, raise a mini flap to debride the place.
YOU CAN ONLY EXPAND BUCCO-LINGUAL.. .. NOT MESIO-DISTAL
I think it is better to remove implant before it integrates and replace missing tooth with bonded bridge.Because even your current complication ends,you may still face problems with aesthetics due to loss of tissues and lack of enough inter proximal space may lead to difficulty in placing or preparing an abutment with proper emergence profile,making an impression for crown,and lack of embrasures may cause periodontal problems.
if you want to keep the implant,Chlorexidine gel or rinse on a gauze to be put on the surgical site and give it some time…If the situation is the same or worth, expose the implant clean and put the healing abutment.
at moment it’s better to rinse the socket and than put cristalline cefazoline inside and fill with any bone graft. than suture.
subsequentelly put in place a provvisory adesive bridge for almost 4-6 months.
than yuo can put a new implant (i use only one piece implants) of 2’8 mm. diameter and as long to arrive till inferior dura madre of mandibula, eventually with such bucco lingual bone expansion.
It’s too big implant diameter… I think it’s better to remove the implant, augmentation. and replace with mini implant in the future.
my friend-do a gentle curttage around the implant and keep rinsing chlorohyxidine.
Been there done that. 3.5 is too wide for mandibular incisors in a dentate patient, not withstanding what your calipers tell you. Don’t believe me? Then take a good look at a lateral cephelogram of “any” patient and you trace the facial and lingual contour of the mandible and you realize that you have only limited space for even a 3.0 size implant, If you follow Tarnow’s principle i.e..
For lower incisors don’t think beyond 3.0 or 2.8 or a bi cortical screw if you have one.
Burnt my hands severely with one case, had to redo every thing including removing the 3.4. and putting a new 3.0.
Wonder why our course teachers and our sales representatives only tell us these things when we fall flat on our face.
Be wise doc, take of that implant NOW, graft, wait 3-4 months and then put a 2.8 or 3.0.
Like to hear what you actually did. Bye.