Fracture of Buccal Cortical Plate During Extraction and Immediate Placement: Best Plan?

Dr. H. asks:
I extracted a maxillary left canine [#11] and immediately placed a 4.1mm implant. During the extraction procedure, the buccal cortical plate fractured. After inserting the implant and obtaining primary stability, I repositioned the broken fragment of bone of the buccal cortical plate, placed demineralized freeze dried bone and covered with a membrane for a guided bone regeneration technique. The site appeared to heal well and the implant appeared to osseointegrate uneventfully. After 3 months, I uncovered the implant and placed an abutment and crown. During the torquing down of the abutment [preloading], the patient complained of pain and slight mobility which persisted for a week. But after 2 weeks now the pain is gone and there is no mobility. Should I just wait and watch now?

7 Comments on Fracture of Buccal Cortical Plate During Extraction and Immediate Placement: Best Plan?

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Presiyan Krastev

1/12/2010

My opinion is that 3 months is too short healing time for the procedure you describe. In this case I would wait 6 months before uncovering and mountage of any abutment. What happeneg means that the fixture was not osteointegrated at that time. Will it osteoinegrate later I don't know. But I would watch, of course for longer period as you suggest. If any mobility or pain appears later, this is a sure sign of failure and my advice would be to remove the fixture asap, gently clean the osteotomy, graft it if possible and leave it heal. 6 months later make a new evaluation of the situation and go on again. Best luck!

Don Callan

1/12/2010

Presiyan Krastev is correct. The implant should be place into non-damage bone and allowed to heal for at least 3-6 months. I feel you may loose the implant since the buccal plate is gone.

Dr.Serge

1/13/2010

You should wait more for such a procedure, the pain and mobility means that the implant wasn't osseointegrated enough at that point to withstand the torque.Is the inplant infiltrated by soft tissue at that point i don't know. if this is the case the implant will fail, if it is not the case waiting another 6 months for a new osseointegration and torque again can be a solution...

Dr.Hajiheshmati

1/16/2010

Thank you all ,the implant became looser, so i removed it.at surgical site there was a V shape missing of the buccal cortical plate,it seem that brocken fragment of buccal cortical plate had no remodelling ability and it was totally resorbed so i put dfdb in the socket and close the cavity with a resorbable membrane.i decide to wait for 3-6 month for another try .any idea Dr.Hajiheshmati

Dr.Ashok kakar.Dentist

1/19/2010

The problem with the above procedure is the time factor.Patient are hesitant to wait thee months for healing period.If we could provide with temporary immediate restorative device and replace it with permanent device after healing.This could be appreciated by the patient.Healing will take it,s own time.Thanks Dr.kakar

Dr. Dennis Nimchuk

1/24/2010

I am a strong proponent of immediate implanting even where there is some labial bone loss. However, if a major segment of the labial plate has detached I believe you put both the implant and the osseous ridge at risk for failure with a possible significant resultant defect. Where there is a large and total separation of the buccal plate, I believe it would be more prudent to make a guided tissue regeneration procedure and then do a delayed implant placement, primary fixation notwithstanding.

Dr.Hajiheshmati

6/9/2010

To day i open a circular area in the gingiva of no 11 and with a flap less procedure i insert a dentoflex 3.5/10mm in the area with excellent primary stability i want to wait for 3 -4 month before the final restoration