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Sinus Tract Next to Tenting Screw After Bone Graft and Implant Placement: How to Resolve?

Last Updated: Apr 11, 2018

After 5 months of uneventful healing of implants in area #8 and #9 with simultaneous Bio-Oss collagen bone graft and titanium reinforced non-resorbable high-density PTFE membrane and covered with a non-cross linked porcine membrane, I now see a small lesion resembling a sinus tract that is present in the immediate vicinity (2mm) of one tenting screw in area of #8. The lesion bleeds very easily and would not heal after I tried to cauterize it with a soft tissue laser. The size of the lesion is about 1.5-2mm. What would you do to resolve this situation since the non-resorbable membrane had to be removed after only 8 months of healing? Please note that area #9 has also received a supporting tenting screw and continues to heal without any problems. Thank you and your help in this matter is greatly appreciated.

8 Comments on Sinus Tract Next to Tenting Screw After Bone Graft and Implant Placement: How to Resolve?

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Dr. Raymond L. Wright Jr.

4/11/2018

Can you provide an X-ray of the area?

Timothy Carter

4/11/2018

1st question: Are the tenting screws still in place? 2nd question: Why use tenting screws in conjunction with Ti reinforced membrane and implant placement? If the screws are still in then just remove them. The Ti reinforced membrane should be sufficient to maintain space especially with implants placed. It sounds like a lot of excess treatment/materials were utilized.

Greg Kammeyer, DDS, MS

4/11/2018

Remove the screw and the membrane. 8 months gives you mature enough bone to go without them and it also gives you a chance to evaluate how well the bone took.

4/11/2018

Itâ€™s only been 5 months, would you wait a little longer or would you have membrane removed. Thanks

Vipul G Shukla

4/11/2018

Any X-rays or close up photos of the site that you can share with us? Was the particulate graft done over intact corticated bone or did you strip the cortical bone first? Any reason for using both types of barriers? How does the post-8 month CBCT compare with the original?

Dr. Gerald Rudick

4/11/2018

After five months, you can simply remove the titanium reinforced PTFE membrane as well as both of the tenting screws. Your graft is not fully mineralized, however it is solid enough to go into the area of the sinus track, scrape out the granulomatous tissue and replant some more grafting material and cover with a collagen membrane.... it is going to heal well, and you can place your implants in three months.

OsseoNews

4/12/2018

Note: We have added a case photo above that we received from the original poster.

Robert

4/13/2018

All excellent and accurate comments and advice I would follow the above instructions Siunus tracts tell you the there is either a soft tissue communication with an open or soft tissue space or that the body has some foreign object it is trying to eliminate, screws, membrane reinforcement, necrotic graft etc Also don't forget to check the pressure of a partial, if that is the transitional prosthetic, on the screw, a mechanical etiology which may be contributing to the problem If the tract stays too long you will loose bone, probably already have, so do not delay Rob

sinus tract with purulent discharge how proceed sinus tract next to implant 8