Wound dehiscence after implant placement: potential causes?
I had a patient who had been edentulous in the mandibular lower right back region for 10 years. After detailed investigations, we installed 2 implants in an uneventful surgery. At 1 day post-op, the patient the area was healing well but the patient complained of a dull pain. The patient then returned after 1 week, and on examination a dehiscence appeared along one of the implants and the patient continued to complain of dull pain. I irrigated with betadine, induced fresh bleeding and re-sutured. Now, I am trying to understand the cause of the dehiscence. The site had minimal keratinized gingiva and I may have tied the sutures too tightly. Could these factors have caused the dehiscence and dull pain? What else do you recommend that I do (I am hoping the flap integrates now)?
8 Comments on Wound dehiscence after implant placement: potential causes?
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PeterFairbairn
11/9/2015
Any grafting or membranes used ? what sutures were used ? the pain may be an issue ...... what torque did you use ??
Sorry more questions at the moment
Peter
PD
11/9/2015
Hello Peter,
I had used continuous interrupted sutures. Also I forgot to mention that I had also disimpacted 48 on the same day . did not use any graft or membrane. Also the patient is not experiencing any pain now. Plus the wound has started to heal by secondary intention. Now I have instructed the patient to use chlorhexidine mouthwash three to four times a day also I have instructed her to visit the operatory after every two days for reevaluation and irrigation.
PeterFairbairn
11/9/2015
Great pain receded , now watch for full closure , if not use healing caps and ensure site is kept clean . Just starting some research into healing by secondary intention over graft sites ........ hope all goes well , monitor .
Peter
PD
11/9/2015
I hope for the same . great your line of research sounds pretty interesting and I think would involve a lot of histopathology. All the best with that. Will keep you updated about my case . also henceforth I will try and back up my cases with good photographs
DrDave
11/10/2015
Without intraoral pictures/ CT or Radiographs no real way to tell you what occurred. Mostly likely too much tension in your flap as you say. You mentioned lack of attached tissue so that's my bet. In the future look to prepare the site to obtain more attached tissue. Site preparation is the key to success often times. Try to get 3mm of attached tisse on the buccal aspect of that implant minimally. if not attempting a ct graft you can make your crestal incision 3mm lingual or palatal from the midline of your ridge then just apically position that flap after your implant placement. Use of alloderm works in the right hands also. Consider not doing a continuous suture or interrupted and place interrupted mattress suture. You will get more "tissue grab" with the mattress with far less tension. My personal preference for sutures is the PTFE by Cytoplast. These have been shown to wick the least amount of bacteria and are very easy to tie without too tissue tension or trauma.
PD
11/11/2015
Thank you sir. I completely agree with you about the suture material and the technique suggested by you. However having 3 mm of attached gingiva is no gold standard (would be a blessing to have it) its absolutely alright to carry out a surgical procedure when 1. The tissue does not move while the patient is performing the daily movements and 2. If the patient is able to maintain oral hygiene. Also instead of going lingual to the crest its better to give a distant incision buccally in the vestibule. Just my opinion.
DrDave
11/11/2015
You may have misunderstood or lost in translation perhaps. The lingual approach is to gain attached tissue for the buccal aspect of the implant where it's needed. Certainly a releasing incision, which is what you are describing, is needed to apical position this flap.
PD
11/11/2015
Sir I did understand your point.. Basically you are referring to an apically displaced flap which would help to create some amount of attached gingiva . But I was suggesting another approach which would involve an incision in the buccal vestibule (distant incision from the site) . I really appreciate you giving in your time and suggestions. Also let me see if I can post the cbct and the iopa of this particular case. Regards
