Draining sinus 2 weeks after implant: suggestions?

I inherited a case of 2 fractured and non-restorable teeth – upper central and lateral incisors – with long-standing chronic periapical infection-periapical granuloma.   I extracted both teeth, did thorough debridement of the granuloma,and used clindamycin and saline wash post excision of the lesion.  I then placed the 2 implants.  After 2 weeks the patient returned with a draining purulent sinus associated with one implant – the lateral incisor.  Should I raise a flap and do further debridement of the infected area or should I explant and debride and re-enter with an implant at a later date?  Requesting your suggestions.  Thanks

11 thoughts on “Draining sinus 2 weeks after implant: suggestions?

  1. Mile Kluth DDS says:

    It looks as if you have lost a good bit of buccal plate . The tissue appears to indicate a failure of both implants . I would flap , evaluated the quality of remaining bone , remove the implants , and regraft the area before you lose too much tissue and bone in the esthetic zone . I would also cover the graft with a collagen membrane . It is not ideal , but retreat , rebuild and come in after 4-5 months with new implants . That is a very dicey area to have a significant infection destroy valuable bone and tissue .

  2. David Anson says:

    If it is in the esthetic zone, then after hard and soft-tissue grafting, I would only place one implant and restore with a cantilever as even in an ideal case, it is rare to get a papilla between two implants.

  3. Matt Helm DDS says:

    These implants have clearly failed. Clearly, infection persisted post surgery. Agree with Mile Kluth DDS. Remove asap, thoroughly curette and disinfect all bone (making sure to remove the sinus tract and all granulation tissue on the inside of the mucosa), graft generously and add a membrane, before this case goes south and you loose too much bone in this critical and demanding area. I would not re-enter before 6 months. Completely bury the implants — cover screw only, no healing caps or healing abutments. Use a flipper as a temp and instruct the patient to not bite at all in the anterior area.

  4. David Sanchez DDS says:

    I know how you would like to save these implants but I am afraid you have to remove them and graft. When placing new ones
    Go with 3.5 mm diameter , placed as palatally as possible and 3mm deep with appropiate narrow healing abutments at least 3 mm long. Cover with allograft and xenograft and CGF . You will recover from this. God bless.

  5. Dreamdds says:

    In my opinion. This will go from worse to worser
    If you are not going to refer to specialist, I would be worried thinking you can recover patient easily
    Get patient on conventional antibiotic (clind or Amox). Plus metronidazole Then carefully open site remove and debride close and place removable temp 6-8 weeks if you try to add the graft volume and membranes needed and then close with that friable tissue it is going to slough and then you are in the 3 year program., then re enter after 2 months with aggressive GBR and wait 6 months. Place implants and wait 4 months or more You are now waiting for a total graft volume to carry sheer stress on front teeth for the patients lifetime . If you loose control of the case you will be paying a lot to someone else for corrective treatment. Please accept this as being helpful. Also get CTs , consent, Tx plan maybe 1 implant as mentioned. Guided surgery for correct implant platform emergence and screw retained prosthetic

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