#3 very small buccal bubble: recommendations?

Last Updated: Sep 07, 2015

In January 2015 I installed an implant in healthy bone at site #3 [maxillary right first molar]. After 7 days I removed the sutures and healing was within normal limits. In June 2015 very small buccal bubble was seen. Purulent discharge was seen oozing only when I pressed the bubble. Patient was placed on amoxicillin 500mg TID for 7 days.

In July 2015 patient returned for a post-operative visit. Infection was still there. I laid a full thickness flap and discovered that the entire buccal wall of the implant was gone. Implant was rock solid from mesial, distal and lingual. I cleaned the site and I placed bone graft, membrane and started the patient on another set of antibiotics. Patient returned in mid-July and I removed the sutures. There was no sign of infection. In Oct 2015 patient returned and the same size small bubble on buccal reappeared and when pressed a drop of purulence came out. What do you recommend that I do at this point?

7 Comments on #3 very small buccal bubble: recommendations?

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Alejandro Berg

09/08/2015

I am sorry to say but common sense and painful experience says, remove implant. debride, graft and start over.... sorry best of luck alex

Dave SIngh

09/08/2015

There was still bacteria on the surface of the implant when you bone grafted it and there. You could try to flap it again. File down all of the exposed surface of implant with a diamond and a chamfer and totally decontaminate the infected threads. rinse and then redraft and place a membrane. Covering tissue has to be healthy and full coverage of the graft site.

JOE IMPLNAT

09/08/2015

LAPIP???

Dr Bob

09/08/2015

You may have had a loose cover screw at the time of the original surgery. Open the site if the bone loss is minimal and at an acceptable level place the healing abutment and see if the implant site heals. If the bone loss is such that the implant does not look as good as you would like it if it were in your mouth, remove it.

sangeeta dhir

09/09/2015

Surely ... this needs an ex-plantation , good debdement , regraft and start as a fresh case

DR S

09/09/2015

YES,i have had this small bubble of pus form when the screw is not secure enough and even had a bubble occurring when an implant thread was above the bone crest (when the implant is manufactured for subcrestal placement), however the bubbble disappears once the healing abutment is placed and the soft tissue above the screw head has been punched out. IF non of these apply to your case, i would try to laser disinfect if possible and place an antibiotic solution in that area ,rather than systemic antibiotics. and be patient,healing takes a long time,recall in 6 months and then check for new bone levels and infection

Dr Krishan Dudeja

09/09/2015

Though unfortunate It is not uncommon.Right line of treatment would be to remove the implant instead of trying your luck another time. Debride the area thoroughly,regraft and wait for 5-6 months before starting afresh.Be open with the patient and explain in a scientific manner,They usually appreciate the straight forward approach.Good luck

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