We did a regular 4.5 ×10 mm implant in 46 region. The buccal bone was fractured coronally thus we grafted the area with a mix of autogenous and allogenous bone graft and a collagen membrane was placed. The implant was submerged. And flap closed with silk sutures. Unfortunately patient visited us after 14 days for suture removal. At this time we soft tissue receded and few implant threads exposed. The implant is not mobile at present. Should I take it out or any way out there to salvage?
Dr. Michael T. comments:
The implant doesn’t look submerged. You’d better take it out, graft and redo in second stage.Dr. Paul Newitt r comments:
Certainly looks like your best option would be to remove and allow for tissue stabilization. How much vertical is available? Can you go deeper on another attempt? Will deeper provide you more Crestal bone buccal?At this point you would be starting with a compromise before you even get to a prosthetic.
frunza mihai catalin comments:
Take it out. The patient also notice there is a problem. And in future there will be disscusions.David comments:
Take it out. This implant is lost. Furthermore, the patient seems to have a very bad oral hygiene, there is a lot of plaque accumulation, maybe even periodontitis. This is a risk factor for implant failure. So before placing a new implant, you should take care of the plaque problem and perio problem.Daniel Sweet dds comments:
First of all, get rid of the silk sutures. Use PTFE. Second,, 2 weeks is too short for this situation.. 3 weeks at least.Steven Andrew Geller comments:
Implant surface is contaminated so must remove. Also get patient's periodontal disease under control before you place another implant.Tim comments:
I rarely recommend removing an implant but in this case I think I would. While it is hard to tell for sure from this photo it looks like you chose to place the fixture in a very buccal position and had it been placed in the center of the ridge no grafting would have been needed and thus no exposed threads. As far as suture material and time of removal I think that is purely operator preference as I can't recall the last time I used anything other than 4-0 Chromic Gut and haven't had to remove a suture in such a case in over 10 years. In addition you might want to work on achieving more passive adaptation for better primary closure as this looks pretty rough.Dr.Mahijeet Singh Puri comments:
This is gone.implant may osseointegrate but you will have threads exposed all around. buccal bone gone atleast 5mm. This will have very bad effect on esthetics and longevity of the implant. Solution. 1.Get the opg done. 2.since this a first molar there should be 13 -15 mm of bone above the inferior alveolar canal. 3.redo it . 4.No shortcuts now. 5.Full thikness flap on buccal and lingual sides. Take out the implant Clean the implant Clean the area Take out the graft. Redo the osteotomy Dig the implant atleast 2mm into the bone. Do gtr procedure Close with no tension using horizontal mattress sutures using 3-0 or 5-0 vicryl sutures . Then don't probe the area . See the results .Manosteel comments:
With a possible 5mm bone loss after healing you will have 50% bone loss which on a 10 mm implant is a failure. looks like you positioned the implant too buccal and had some suture line opening . Remove the implant graft the site with autogenous allographic mix with PRP, tent a titanium membrane with tenting screws make a periosteal release incision and spread out the flap with Metzenbaum scissors, making sure it will close . Place a PRF membrane and close with pfte or Vicryl sutures . in six months re try placing aa new implant ,verify bone volume with new cbct. While waiting get that guy to work on oral hygene and to quit smoking!Tim comments:
Why not just remove and place the implant more lingual, where it should be, and eliminate all of your fancy grafting suggestions... especially on this smoker with poor OH!!!Shweta Gupta comments:
Thank u all for ur suggestions. Planning to remove it. This one is current pic. 