I have a 69 year old female patient in good health. She is a non-smoker. She came to see me due to failure of her implanted supported fixed prothesis. She had 5 Astra 3.0 implants placed over 5 years ago and all appeared healthy and osseointegrated. However the design of the fixed bridge was poor with uneven contacts and subsequent fractured screws. Implants had been placed in #6,7,10,11,13 sites [maxillary right canine, lateral incisor and maxillary left lateral incisor, canine and second premolar; 13, 12, 22, 23, 25]. I have gone through all the stages of making a hybrid bar overdenture and 2 days before final fit she presented with severe swelling and pus draining from the implant in #11 site. The implant itself still appears to be solid but there is an obvious buccal defect. I have curretted the area, irrigated, used topical and sytemic antibiotics and will be reviewing her in a week. My dilemma is what should I do next? If this implant fails I can still use the overdenture on the other 4 remaining implants. However if the infection spreads to the adjacent implant, she could lose the potential to use the overdenture.Given the risk should I be more proactive in treating the infection? My plan is to attach the uniabutments and bar at the next visit and monitor. I am worried this may not be an aggresive enough approach. Any thoughts?
(click images to enlarge)
PA at time of presentation with acute infection draining from most mesial implant
bar of overdenture on 5 Uni abutments ready to fit
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