Found Sinus Tract After Uncovering Implants: Course of Action?
Dr G asks:
I have just begun to surgically place implants. I have just encountered my first complication. I placed two implants in the posterior mandible six months prior. I had excellent primary stability and the implants healed uneventfully. There are no objective signs of any problem and the patient does not report any adverse symptoms such as pain. When I made my initial crestal incision to uncover the implants after four months of healing time, I found a small but very definite sinus tract/fistula. This sinus tract has persisted now for two months. What should I do? Is there some way to reflect a full thickness flap and surgically incise the infected tissue around the implant and disinfect the implant surface? Any advice?
6 Comments on Found Sinus Tract After Uncovering Implants: Course of Action?
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peter fairbairn
11/9/2010
Was there a spomtaneous exposure of the implant ? If the radiograph looks OK maybe raise a small flap and fit a healing type cap.
mike ainsworrth
11/9/2010
I agree with peter, if the tract is directly over the cover screw, you probably have a small communication to it, just proceed as normal and you will be fine (think of it as a mini pericoranitis).
sv
11/9/2010
You may have a loose cover screw causing it. Like mike said you may proceed as normal.
Dr. FGS
11/9/2010
You have not mentioned where the sinus tract is and what the radiographic findings are. With more information, you can get more help and the respondents will not have to guess as much. Since the tract has persisted, did you place a size 30 gutta percha in the tract and trace it? Have you removed the cover screws and placed the healing abutment?
Dr. Mark Chishom
11/10/2010
Trace the fistula. It is probably the cover screw. Why did you wait so long to uncover?
mark harari
11/10/2010
I have also a fistula and I traced with a probe , it's in direction of the bottom of the implant. No socket between the bone and implant, maybe a problem with the bio oss into the sinus lift ? I have X-rays but no way of sending it
