Implant thread exposed in lower lateral incisor: options?
I have a 30 year old female patient who presents with an implant in the mandibular lateral incisor site with 2 threads exposed on the labial side. Her main concern is aesthetics. The implant was placed 4 years ago at another office. I would like to avoid explanting the implant, if possible. What else can I do to cover the threads recreate an aesthetic gingival architecture?
18 Comments on Implant thread exposed in lower lateral incisor: options?
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Gregori Kurtzman, DDS, MA
7/18/2017
Need a clinical pic and radiograph to properly make recommendations.
Howard abrahams
7/18/2017
Smooth exposed threads with fine diamond bur under magnification to prevent plaque entrapment. Remove current crown. Make a new abutment and crown. The crown should have a ridge lap to cover the exposed threads and there will be gingival colored porcelain. That's your least invasive treatment. Good luck.
samir
7/19/2017
Ok Thanks
Dr. Fotis Roilos, MSc
7/18/2017
Classic! Do you have any intraoral pics? Whats is the tissue biotype? Maybe a free ginginval graft from the tuberosity and tunneling? If we have more info e.g. xray and intraoral pics I could be more precise!
Nick
7/18/2017
Do you really believe that tissue coverage will solve the problem long term?
Dr. Fotis Roilos, MSc
7/18/2017
No...! But if it works will be a good patch for some time... because soft tissue without supporting bone underneath it... will start to get thin again over time and probably resorb again! But from the tuberosity that I mentioned you get better long term results!
samir
7/19/2017
I am not sure but as the patient doesn't want any invasive procedure now, there is limitation for treatment option. But personally I wanted to know the treatment option.
samir
7/19/2017
Ok .Thanks
Dr Michael Hase
7/18/2017
Remove the implant as this scenario is typical when ridge was too narrow for implant choice or implant was misplaced initially. Issues may include lack of support for adjacent papilla and eventual vertical migration of support for adjacent teeth causing root exposure. Most predictable salvage would be fixed bridge restoration replacement.
Gregori Kurtzman, DDS, MA
7/18/2017
Thats a bit extreme solution with the minimal info presented. before I would recommend explantation I would want a CBCT to see cross sections to see how much bone is on buccal and lingual. And there is the possibility of flap and placement of osseous graft. Explanting is always the last resort.
John Highsmith DDS
7/18/2017
While helpful, it's difficult to draw a lot of subtle conclusions from a CBCT due to scattering from the metal. I've had a lot of cases where I do a post op CBCT in a case where I visualized the buccal bone over the implant, and in the scan it looks absent.
samir
7/19/2017
Thanks but her main concern is cosmetic and implant is stable
perio d
7/18/2017
Her chief concern here is cosmetic, exposed metal, even though she and the dental team are the only ones who are able to see it. I can understand this concern in a 30 yo woman. I agree, without other information in the form of photos, x-rays and CBCT scans there is no rationale to suggest radical treatment such as explantation. A subepithelial(from the dense tissue of the tuberosity) graft can sometimes cover the small amount of metal exposure described here, thereby improving long term gingival margin stability. In most instances such as this, grafting gingiva is the most I would ever propose in an otherwise healthy situation.
Gregori Kurtzman, DDS, MA
7/18/2017
Any possibility of posting a clinical pic. if shes happy with the rest of the crown the solution may be to do a pinhole type technique and move the tissue more coronal to cover the threads and thicken the gingiva slightly. If shes not happy with the overall crown then replacing the crown and have the margin slightly more gingivally will solve the issue. is the tissue there healthy (noninflamed) or irritated? is the crown a PFM or ceramic?
samir
7/19/2017
Thanks For your valuable comment.
Crown is ceramic and gingiva is healthy I think this is a good option
samir
7/19/2017
Thanks for your suggestion. Patient does not agree for graft, which has been suggested, but I would like to know about long term result of subepithilial graft .
Dr. Elijah Arrington III
7/19/2017
Brother....May we please have pictures and x-rays please prior to giving you advice? The more information you give us the more we can give you. #digidoc
Bülent Zeytinoğlu
7/26/2017
Exposed threads harbor bacteria and it is almost impossible to eliminate these colonies by no means, you can only disinfect the metal surface by chemicals but this does not mean that the region is sterile or has its normal flora so if you cover the threat surface by a soft tissue graft you will form a infected marginal sulcus which will retract with in a very short time besides causing a lot of trouble to you .If I were you I would leave the case as it is.
