Bone loss on lingual and pocket bleeding: recommendations?
This is a follow up on implant case, Flap dehiscence, that can be found here.
It is now at the 36 day mark. The patient’s soft tissue coverage has improved, as is visible on the photograph. The implant is still stable. However, there is bone loss on the lingual. On gentle probing, I get pocket bleeding and I can feel 3 – 4 threads by tactile assessment. No purulent exudate as of yet.
I flushed the area out with Peridex and am leaving it alone for now. Would grafting likely be needed, or some sort of thread smoothening, and how soon should I do it? How do you recommend that I proceed at this point?
6 Comments on Bone loss on lingual and pocket bleeding: recommendations?
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peterFairbairn
10/19/2015
If Possible get a healing cap on this ASAP...
Peter
Beginner
10/20/2015
Thanks Peter, will check with my supervisor if I can do so.
CRS
10/20/2015
Agree healing head won't hurt this since it has been exposed from the get go. If it integrates you will know in the next 3-4 weeks. A CBCT will be be good to see if you can live with the bone loss long term. I suspect the implant may have caused some bone necrosis at placement easy to do with a Straumann if implant profile drill not used correctly, this system I find most technically challenging but it is a great implant to restore. Not sure why a bone level placed in a non esthetic area. Going in early on just caused more trauma one needs to understand how things heal, that's the secret of implants it is surgery not technical. Now here is the most important Pearl if the integration is not good don't restore it, remove and start over or you will be chasing this implant as a loss leader and an unhappy patient. In my experience it will need to be removed eventually if the bone support is not adequate. An implant is most stable at placement it typically does not improve over time in these cases. Good luck at least you are honest and trying to learn, good for you.
Beginner
10/20/2015
Dear CRS,
Thanks for the sound advice, will consult my supervisor and do as you suggested. Just wondering, if I created bone necrosis with the profile drill, would that have been a reason for the flap breakdown? Or are they two simultaneous separate problems - poor flap design and concurrent dead bone?
Thank you!
CRS
10/20/2015
Hard to answer since I was not there, in my early experience with Straumann implants the profile drill can be used in between the enlarging drills to help the drills not skip on the more dense crestal bone. If the drilling is too fast the bone can get eaten up. Sometimes when seating the implant too much force can cause necrosis. Does the patient have any pain? Sometimes as an implant fails and becomes mobile patient will have pain, indication to remove it. I think it is the bone because a poor flap will still cover the bone in 10-14 days. Necrotic bone won't be covered. The trick is the judgement call on when and if removal indicated on an "iffy" implant. What does your advisor say?
Dr Shyam Mahajan
10/23/2015
If there is no exudate, just wait for few more weeks. Keep the area clean with luck warm salt water gargles & clorhex galgles. Do not probe at this stage. If gingival former or healing head to put , immediately at the time of implant placement or after 3 months. 2nd to 6 th week is more dangerous to try to remove cover screw & do anything with implant.
