Dr. Z asks:
I placed Straumann ITI bone level implant 4.1/14mm in the #9 area [maxillary left central incisor; 21] 8 weeks ago (see attached case photos). There was very limited bone volume, good primary stability, but almost 80% of the buccal bone had to be grafted with Bio-Oss [Osteohealth] mixed with autogenous bone collected from a bone trap. A Bio-Gide membrane [Osteohealth]was used.
Following the implant placement and bone graft, the patient failed to return for 8 weeks. Patient now presents with a dehiscence in the crestal region where the cover screw can be seen. Some of the Bio-Oss graft has been lost, compromising the buccal alveolar crest area. There is also a sinus tract on the buccal of the graft site which is actively draining. Patient has also complained of feeling ill. I have prescribed 500mg of amoxicillin and 400mg of metronidazole.
She will be returning in 2 weeks when I will attempt to cover the dehiscence. I will use a split-thickness flap which I will rotate from the palate over the dehiscence and attempt to submerge the implant. But, should I just be cutting my losses here, and would it be better for me to just remove the implant, graft and place another implant later? Or, should I proceed with my protocol? I really would appreciate advice.
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