Buccal Cortical Plate Fracture with Friadent XIVE Implant: Suggestions?

Just leave it. with soft tissue retraction and exposure of the top of the cover screw, the marginal tissue might stabilize without exposure of the implant shoulder. Or, you might find the facial aspect of the implant shoulder exposed, in which case you can do a secondary soft tissue/connective tissue graft at second stage. if the CT graft is used, place the healing collar one size smaller, at the same time to allow for a margin of tissue to bulge over the implant platform. good luck.

Dear Dr. SC With the tooth having a history of sinus tract and infection, a one month waiting period is not enough for proper healing to take place. The buccal cortical plate was already compromised because of the infection.This had to happen. It is much more predictable to extract the tooth, graft the site, wait for 4-6 months then place the implant. what type of membrane did u use? most resorbable membranes require full soft tissue coverage. If a resorbable membrane becomes exposed in the oral cavity,it may become infected and would have to be removed, which if happens would mean failure of the grafting around the implant. i wish u luck with this case

Dr SC I have several suggestions that may help in addition to the other comments posted. If the cover screw was visible after only one week ( during suture removal, I would guess that you may not have released the periosteum enough to obtain passive adaptation of the tissues since this is one of the most common causes of surgical wound opening so soon. Another cause may have been if you did not use matress sutures, since they evert the flap and are less likely to open. As far as the exposed cover screw is concerned, it would not make the case fail, since one stage implants create the same conditions, but you need to check radiographically for bone loss which could be a sign of failure. Hydroxyapatite and GTR are generic terms that do not give as much information as the actual product used, and it would be useful to know these details. I hope this helps some. Good Luck

sir, i fully agree with Dr SC, RELEASE IN PERIOSTEUM IS NOT SUFFICENT,NOW WAIT FOR ALMOST 4 months so that the already compromised buccal plate will have osteogenic recorrection so that on again placing the membrane it can well adapt n ur post complication can be avoided

Dear dr.SC I thınk in the following months retraction of the buccal marginal soft tıssue with the HA graft will take place because you have tried to restore the fractured bone by an ınorganıc material. HA does not adhere titanium surface alone you should have added some bone graft material mıxed with patients blood.Besides as mentioned before one month is not enough for bone healing especially ıf ıt has been infected before we have to waıt for atleast for 4- 6 months.If the above clinical symptoms appear please clean the nonvital tissues and HA remants polish the fixture suface do the grafting again if the implant is not loose and stable. Good luck.