I had placed an immediate implant in the mandibular molar extraction site. The implant had excellent primary stability. On the second day post-operative the sutures had opened up, in a manner that there is no way I could close them back to achieve primary closure. It was my mistake to close the wound site flaps under tension and so the flap opened. Now the condition is that the cover screw was exposed and I replaced it with a transmucosal healing abutment. This allowed closure of the surgical flaps around the healing abutment distally, bucally and lingually, but there is a wide gap on the mesial you can see into the extraction socket and oral fluids can go in. I can even see the implant threads from there, without manipulating the tissue and a little of the buccal bone is also exposed. I understand that the exposed bone will die, but my implant is still a little deeper.
As I am encountering these complications for the first time I would like to hear from the more experienced clinicians -what should be done? The implant is not mobile at all, no sign of infection. I have asked the patient to keep the area clean and do warm saline rinses 3-4 times a day, be on semi-solid diet and the patient is under my constant observation. What are the chances of the bone forming on the mesial area that is exposed to oral fluids? Should this be left alone for 3-4 weeks and then re-evaluate? Or should I remove the implant now and graft the area?
Its a learning case for me. Your advice will be highly appreciated.
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