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How Do I Determine that Implant Site is Clean from a Previous Infection?

Last Updated: Jul 12, 2010

Anon, a prosthodontist, asks:

I have a patient who had a previous chronic periapical infection on 31 (lower right second molar). He had persistent pain and fistula with pus coming out on finger palpation.

The 31 was then removed with antibiotic prescriptoin (augmentin) and curreted to remove the granulation tissue and irrigated and the patient had 2 implants placed on 31 and 30 after the site healed 4 months later. At the time of implant placement, patient was assessed for any symptoms: no pain,no pus on palpation and no fistula. The bone and gingiva seemed healthy. A periapical radiograph was also taken, and the site seemed clean.

After two months of implant placement, the patient came for a regular check up, and I found there was pus coming out from implant 31 on light finger palpation (the implant was remained uncover and untouched). The patient had no pain or any other symptoms after the implant placement. The healing was uneventful.

I have also noted from previous posts, that one of the common reason for implant failure is previous tooth infection.

I was just wondering what are the points that you will examine to determine that the site is ‘free and clean from any previous infection’? And how should we clean the extraction site at the time of extraction without jeopardizing the remaining thin wall bone?

thx for the comments.

4 Comments on How Do I Determine that Implant Site is Clean from a Previous Infection?

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Peter Fairbairn

7/12/2010

Possibly lost the buccal plate here if no real radiolucent areas , so can raise flap and assess. Yhen can remove soft tissue reprepare the implant surface and re-graft . Good luck Peter

Peter Fairbairn

7/12/2010

Sorry also was there a spontaneous exposure of the healing cap? Is there a peri-implant loss area and finally was there a shortage of attached gingiva?

Dr MILAN KUMAR

7/14/2010

if its in maxilla do throughly verify the cortex of bony is healthy by conebeam focous. 2nd preparation of site is very important, third is debridement. 4th allow the periosteal tissue to heal up for atleast 6 weeks before PLANNING for putting implant at previously infected site. on raising of the flap acces proper 4mm above the site.

mohammed Jasim

7/17/2010

at the beginning we should remember the regulation of any infection treatment 1-Antibiotic 2-Pus drainage 3-remove the cause so the problem now in knowing the cause and remove it, I don t think that the cause is from previous infection ,the cause due to implant placement,contamination,overheated drilling,pressure necrosis,exposed implant,tissue interruption between fixture and cover screw

how do i make the transition to cone beam volumetric tomography how do i determine if the implants are osseointegrated