Keystone One-Stage Implant Discovered a Dehiscence: Should I Remove the Implant?

Dr. SC asks:
I placed a Keystone 5.5 x 8mm implant in #19 site [mandibular left first molar; 36] 2 weeks. Upon completion of the installation, I discovered a dehiscence on the lingual side of the implant with one thread exposed. The reason for using short implant was to avoid the inferior alveolar nerve which was located about 10mm from the alveolar crest according to her CBVT scan. There is adequate primary stability.

However, I am worried about the epithelial downgrowth from the lingual side which I am concerned may interfere with the apposition of bone and compromise the osseointegration.

Should I remove the implant right away, bone graft, and delayed another implant placement before any integration occurs, or should I leave it and prep the margin gingivally 3 months from now if it integrates?

4 thoughts on “Keystone One-Stage Implant Discovered a Dehiscence: Should I Remove the Implant?

  1. dr. gerald rudick says:

    Dear SC,

    Since it is only 2 weeks since you placed the implant, and there is adequate primary stability…why not try a graft procedure.

    I would recomend using PRP, reflect the tissues well so that when the particulate graft is placed and covered with a membrane, you will get good primary closure.

    For added insurance, wait six months before exposing the implant, which at that time, hopefully will be covered by bone which you will have to cut away to expose the implant.

  2. Dr. Mike says:

    Why not use PDGF with PRP. When combined with BMP-2, it seems to give the best result. If you cannot afford the BMP-2, then switch with PRF mixed in a 20:1 ratio with PPP and you should see a nice result also. I do this for all my implant cases and have never seen a failure.

  3. Carlos Boudet, DDS says:

    Dr SC
    Your best chance for the best outcome is to graft the area at the time of placement if you see less than 1.5 to 2 mm of bone buccal or lingual to the implant.
    Post surgery, your safest route is to make sure you have tension free primary closure of the surgical flap after your grafting, and use mattress sutures for flap closure to avoid a dehiscence of the flap closure. This will require releasing periosteal incisions.
    You want primary closure and the implant buried.
    If the threads have been exposed to the oral cavity during healing, make sure to treat the surface appropiately if you expect bone apposition to it.
    Good luck.


Leave a Comment:

Comment Guidelines: Be Yourself. Be Respectful. Add Value. For more details, read our comment guidelines. Though we require an email to comment, we will NEVER publish your email.
Required fields are marked *

Posted in Clinical Questions, Dental Implant Complications, Surgical.
Bookmark Keystone One-Stage Implant Discovered a Dehiscence: Should I Remove the Implant?

Videos to Watch:

Dealing with the Implant Gap

This short video discusses how to best deal with the gap after immediate implant insertion[...]

1 Comment

Watch Now!
Lower Right Molar Extraction & Immediate Implant Placement Using i-PRF

In this video, the lower right second molar was extracted and grafted with i-PRF and[...]


Watch Now!
Maxillary Implantation with Treatment of Chronic Sinusitis

This video shows two cases where implants were placed following treatment of Sinusitis. [...]


Watch Now!
Suturing in Guided Bone Regeneration

This video provides clinical tips for suturing techniques in Guided Bone Regeneration. In Guided Bone[...]

1 Comment

Watch Now!
Socket grafting with Collagen Dressing and Bond Apatite

This video demonstrates socket grafting with just bond apatite and a collagen wound dressing.[...]

Watch Now!
Dental Implant for Lower Right Second Molar

This video shows implant placement on the lower right second molar.[...]

Watch Now!
Saving a Bridge with Periodontal Therapy

This video shows a case involving a 48-year-old male who was referred for periodontal treatment[...]

Watch Now!
Immediate Loading Full Arch

This video shows a case of Immediate loading of a full arch with simultaneous guided[...]

Watch Now!
Apically Repositioned Flap Technique Around Implants

The apically positioned flap is a commonly used surgical approach, that may help the long[...]

Watch Now!
Digitally Planned Bone Augmentation and Immediate Implantation

This video shows a case using the Ring technique to provide bone augmentation along with[...]

Watch Now!
AnyRidge Implants: Replacement of Upper Left Molars

This video shows the replacement of maxillary upper left molars with Megagen AnyRidge Implants.[...]

1 Comment

Watch Now!
Guided Implant Surgery & Immediate Temporisation

This video demonstrates the placement of a missing pre-molar using computer-guided surgery and immediate temporization.[...]

1 Comment

Watch Now!