Dr. B. asks:
I placed a dental implant in the left posterior maxilla in the first molar site [#14] following augmentation of the site with a block bone graft which I harvested from the ramus. At the time of implant placement I performed an indirect sinus lift and the patient developed a sinus perforation. I placed the patient on broad spectrum antibiotics and an antihistamine. The patient responded favorably and the implant has osseointegrated.
The patient is now 5 months following the implant surgery. There is a small buccal bony dehiscence of approximately 3x5mm which extends from the collar of the implant cover screw and distally to the mesial line angle of the second molar.
Today I gently removed some necrotic bone with a round burr so that the dehiscence is now concave, thinking that soft tissue may now be better able to spontaneously develop over a concave defect. The patient also just today informed me that from the time of implant placement, she wakes up approximately 1 day per week with a mild swelling under her left eye which resolves as the day progresses.
Thinking the patient has a chronic sinusitis, I took a panorex which failed to show anything significant. The sinus membrane is clearly visible and passes superiorly to the implant apex. The implant has bone surrounding it completely.
Clinically, the implant is stable, it is not sensitive to percussion and appears to have good soft tissue health excluding the dehisced area. What is your recommended next step? To remove any remaining necrotic bone and place patient on broad spectrum antibiotics and rinse or to restore the implant?