Crestal swelling 3 weeks after the implant placement: options?
Three weeks after surgically installing an implant fixture without complications in an healthy patient, a swelling of the peridontium occurred supracrestally. There are no other relevant signs other than a soft tissue swelling. What are the best options here? Should I treat this like a periodontal or gingival abscess and incise and drain it? Should I place Arrestin in the site after draining? Lay a full thickness flap? Thanks for any ideas.
4 Comments on Crestal swelling 3 weeks after the implant placement: options?
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CRS
2/27/2013
I would take a periapical X-ray, loose cover screw,early infection, trauma to area? I would place the patient on oral antibiotics and follow closely. My rule of thumb is that most osteointegration failures happen between 6-8weeks, advise the patient what you are watching for. If there is bone loss or failure a this early junction then remove implant and start over depending on the radiographic and clinical findings.
naser
2/28/2013
supracrestal suppuration weeks after implant placement can occur due to several reasons , the most common cause is either few threads of the implant are exposed or the implant fail to osseointegrate at all.
TOBooth
3/4/2013
if you had good primary stability take a pa, most likely a loose cover screw. If so remove gently and place a healing abutment with care to a low torque ie 10ncm and try place a temporary acrylic denture well off the implant in centric occlusion and any guidances. Even better hopefully you could have a retainer that could be used for a temporary bridge well off the tissue. Advise extreme caution and avoid the area along with saline or chlorhexidine rinses x3 daily.
You really do not want to leave the implant partially exposed it looses alot of crestal bone. The literature also suggests smaller exposures cause more bone loss.
More info would be good.
my 50p s worth!
greg steiner
3/8/2013
If you have a marginal bony defect I suggest you treat this ASAP and not allow the lesion to become chronic. Detoxify the implant surface and bone graft. This type of lesion can be a result of handling the cover screw with gloves(covered with bacteria) prior to placing the cover screw in the implant. If you need to handle the cover screw do so with sterile gauze and you should be able to prevent this problem in the future. Greg Steiner Steiner Laboratories
