Early implant cover screw exposure: solutions?

What Implant did you use? (HI, HE,CM) I wouldn't do a thing right now. Email me more details if you may [email protected]

Sadly this is a classical decision time and only the surgeon really can make a choice as he knows the details of the case. CHX mouthwash and watch ! Peter

Normally an exposed cover screw is not a big deal there can be soft tissue retraction or thin tissue. But what concerns me is the collapse and moving the implant which may indicate that the bone is too thin or of poor quality. In these cases I expand the bone with motorized expanders and graft. At 12 weeks I can place the implant with confidence knowing there is enough bone for osteointegration. I'd remove and start over vs nursing this thing along the implant needs enough bone and initial stability. Now a days with the grafting techniques available this scenario can be avoided trying to patch it with bio OSS is not the treatment of choice.

I would place your healing abutment or transmucosal former of some sort and treat it like a one stage. After 1,2 and 3 months assess. If any mobility take it out, graft and do another one immediately or delayed. If no mobility then restore.

Did place a membrane over your graft or you just placed bioss and covered with a gum? Looks like you lost your graft on buccal. How big was your implant? If its only 2to 3 mm coronal bone and the rest of it you have a good bone support, and you have not less than 11mm implant then just place patient on Peridex rinse 3 times a day and let it heal. Make sure patient has enough attached gingiva otherwise you will continue loosing bone around your implant. Of course it's hard to say exactly without seeing actual case, x-rays or photos. If you know anyone locally or any friends who knows let them see the case and give you feedback. Good luck

Thank you every one for your advice.

Cover screw exposure is not an issue have the patient keep it clean using CHX and a cotton swab

I agree with opinion of CRS.

Leave it alone!

As suggested above, it is a little early to start worrying about an exposed cover screw. In future when using a particulate graft material, it is generally best to separate the graft from the mucosa with a membrane. As a new comer to implant dentistry, make a small investment and buy a centrifuge and read up on Plasma Rich in Growth Factors (PRGF). You will learn how to prepare PRF ( Platelet Rich Fibrin) which can be used as a biological membrane with growth factors to enrich and help your grafts develop. In this case, wait a few months, see where the soft tissue settles and decide if the defect can be hidden prosthetically, or is another graft indicated. Gerald Rudick dds Montreal

Treatment recommendations for this particular case is difficult without more information, but I'd like to address the problem of spontaneous early exposure of an implant. It's not such a good idea to leave an implant cover screw partially exposed, because you will incur more crestal bone loss the longer it is partially exposed. Please refer to the following articles: "Spontaneous Early Exposure of Submerged Implants: Histopathology of Perforated Mucosa Covering Submerged Implants", Tal and Dayan "Soft Tissue Exposure of Endosseous Implants Between Stage 1 and Stage II Surgery As A Potential Indicator of Early Crestal Bone Loss", Toljanic "Spontaneous Early Exposure of Submerged Endosseous Implants Resulting in Crestal Bone Loss: A Clinical Evaluation Between Stage I and Stage II Surgery", Tal "Diagnosis, Clinical Classificatiion and Proposed Treatment of Spontaneous Early Exposure of Submerged Implants", Barboza

Do II phase. Remove the cover screw and put healing abutment to keep as much as possible healthy soft tissue around that implant. If during the removal of the cover screw the implant gets removed you have shortened the agony of the implant and you have a good chance to do it proper way with bone grafting before the implant placement. If the implant is stable sit and wait. I hope that the implant is not in the esthetic zone. Good luck!

No problem, no solution.

Hello If only the cover screw is exposed, then its not a big deal but If there is already bone loss on the buccal side then it is definitely going to progress furthermore with time. Ideally you should remove the implant, graft bone, wait for 3-6 months and then implant according to the available bone. Best of luck buddy.

Question for Df Gerald Rudick I am interested in the Platelet Rich Fibrin membrane you mention. What is your experience with it and if you have any information on who supplies the centrifuge I would really appreciate it. Thanks