Flap Fails to Close using MIS 10mm Implant: Does this Need Further Treatment?
Dr. K. asks:
I placed an MIS 10mm implant in the #30 site [mandibular right first molar; 46] in a two stage approach, and covered the implant with a cover screw. I then closed over the implant site with a mucoperiosteal flap secured by 3 silk sutures. All looked good two days later, but at the suture removal appointment 10 days post-op, I could see the top of the cover screw where the flap had failed to close. There was no swelling or inflammation of the tissues. The patient was instructed to mouthwash to keep the area clean. Does this need any follow up or further treatment?
9 Comments on Flap Fails to Close using MIS 10mm Implant: Does this Need Further Treatment?
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Neda Moslemi
4/26/2011
Dear Dr. K.,
Do not worry about it.
But, if bone dehiscenc or perforation occurred during surgery or primary stability was not achieved there is a risk for failure of implant.
Precise oral hygiene regimen is recommended in healing period.
Talal
4/26/2011
If you have a good initial stability I would suggest to remove the covering screw and place a healing abutment.
Dr.Alejandro Berg
4/26/2011
if its stable, a good healing abutment and dont worry this has turned into a one stage surgery
David Anson
4/26/2011
Exposure of the healing abutment 10 days latter is not by itself a problem. I would suggest using resorbable sutures, as it is more comfortable for the patient, the soft tissue responds a lot better as there is no bacterial wicking into the surgical site (the soft tissue has a better appearance as well), and there is no appointment for suture removal.
Richard Hughes, DDS, FAAI
4/26/2011
Keep it clean with peridex. Do not worry about this.
TBooth
4/27/2011
Good primary stability on placement? if so place a healing abutment as soon as the smaller the exposure the harder to clean and teh more likelihood of bone loss-why risk it? no local will be needed either!!
Dr. C
4/27/2011
Dr. Anson,
You stated using resorable sutures. What kind do you prefer? 3-0 chromic gut? I use vicryl quite a bit. But, it states it is a "braided" suture. Will this type of braiding in a resorable type suture lead to bacterial wicking?
Manosteel
5/3/2011
Maybe I'm reading this wrong but.....On closure do you have a tension free flap? If not do a periosteal releasing incision to pull up more tissue. Try using horizontal matress sutures to initially secure the flap then follow with continuous. You'd be suprised at how many don't know how to do either one. If a cover screw exposes you can leave it alone or place a healing abutment on it if you have good stability the implant at this stage isn't a failure and probably won't be in the future.
Dr. Dan
5/3/2011
Don't worry about it as long as the implant has primary stability. Just let the patient be aware that he/she should keep the area clean.
