Fenestration after four months post op: best way to proceed?

Thanks Peter great minds think alike! The only time I use a membrane is if I am concerned about epithelial in growth since the blood supply is compromised especially in a cortical onlay graft. I am moving away from the bovine and porcine products and going with natural human fibrin, human amniotic or Teflon which only stays in temporarily ah a tissue guide to allow guided regeneration. I think the body handles human tissue best for regeneration. But I routinely don't use membranes just a healthy flap with primary closure. For larger more complex grafts then a membrane may be helpful for space maintenance. I am interested in this post since at four months I have seen this complication and it can vary from, non-integration, Periimplantitis, graft loss or simple graft sloughing with an intact integrated implant. I always question when to intervene, regraft, debridement, laser (lapip) or replace the implant. It seems six and fourteen weeks are critical times. Bacteria at implantation surgery or host factors with latent bacteria . Good to hear from you as always.

Yeah sb oms. Atomize the unwanted part of the fixture with a precision titanium atomic blaster. Make sure the graft is closely intimated with the peripheral raw bleeding bloody bone. Titanium dust is biocompatible. Drill some holes through the surrounding cortical plate if necessary. If the implant is already osseointegrated, that is what I will do for myself. The alternative is that in removing the osseointegrated implant, there will be a big bony defect which is a prologue for prolonged big procedures that may result in a bigger problem than before. Happy grinding!

K F Chow puts it coarsly, but in reality this procedure works if the problem is limited to the facial aspect. I've salvaged to similar cases utilizing basically this approach.

What is the purpose of implant thread removal ? Removing contaminated surface or to get space for a graft. Will the bone adhere to the naked titanium or a non resorbable bone patch, hard set. Could the surface just be decontaminated with laser or chemical? I've seen thread removal for hygiene in the exposed oral cavity? I just did a case where there was a void it the bone with granulation tissue since the extraction site was not grafted and it was a endo failure. I curetted, used tetracycline and placed cadaver bone. Will wait 12 weeks and pace the implant. Could the bacteria in the bone be the problem? I see this and wonder that if the bacteria and epithelium is removed the graft heals well tells you that it s safe to proceed with the implant. However the cutting of the threads can expose bacteria. Perhaps a technique to truly decontaminate the implant site at extraction or placement. This requires some thinking!

P.S. Peter, no membrane!

Not just the threads...... the implant proper itself. The purpose of removing the exposed surface of the implant at least 2mm deep is to allow a reasonable thickness of bone graft to be placed against the implant as well as intimately with the surface of living bleeding bone. If osseointegration of the implant has already taken place, it should not be removed but grafted where it's nakedness show. Removal makes no sense because it will result in a large defect in the bone that will be difficult to address and will require a bone graft any way. Rehabilitating an already osseointegrated implant is better than to remove it and end up with a bigger challenge! But if it is not osseointegrated, then remove it.

Total judgement call at surgery, I have been burned also in trying to salvage a preloaded implant and have also been successful with salvaging one. That's what I like about wisdom teeth they don't grow back!