Localized Swelling Around the Healing Cap: What Happened?
Dr. AS, a general dentist, asks:
I placed an implant and had an uneventful healing. I removed the healing cap to make a final impression. I noticed that the healing cap was loose but there were no pathologic signs or symptoms. The implant fixture was not loose and did not spin. The patient returned the next day with pain and a localized swelling around the healing cap. I prescribed amoxicillin 500 mg qid and chlorhexidine 0.12% rinse bid. What happened and what should I do?
6 Comments on Localized Swelling Around the Healing Cap: What Happened?
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sb oral surgeon
6/29/2010
when the healing cap is loose your whole system is contaminated. rinse out the implant (i fill the implant body with metroniadozole gel)clean the tissues, clean the healing abutment, tighten the healing abutment, use chlorhexidine for a week and you should be fine.
your patient has a minor infectious process due to plaque and bacteria being introduced into the peri-implant tissues from a loose healing abutment.
no systemic anti-biotics are necessary.
Dr. michael weinberg
6/29/2010
If the healing collar was loose then soft tissue was growing in beneath it and the head of the implant. When you retightened it, you probably had some impingement of the soft tissue. The same thing happened to me when one of my healing collars became loose. I was in pain for a day and then it went away. DR. sb is correct as to how to treat it locally and not systemically. As long as the implant isn't loose, you are generally OK.
Carlos Boudet, DDS
6/29/2010
The loose screw was the culprit.
It has probably happened to all of us and sb oral surgeon gave you the correct treatment steps.
Soft tissue, microorganisms in sulcular fluids, they can be trapped and exposed if the screw loosens.
Keep the connection clean and dry when you have to remove components.
Thomas Cason MFOS
6/30/2010
Prescribing antibiotic is definately overkill!
Once you had cleaned the area and retightened the abutment to prevent movement it will heal up.
Ensure the patient maintains good hygiene in the area
Joshua Shieh
6/30/2010
Just experienced one situation a few days back (swelling, pain,fever)..as Dr. sb oral surgeon says...it is becoz of the infection set in during the abutment connection. Broad spectrum antibiotics with chlorhexidine should help.
Rob Smith
7/17/2010
How do you make the mitronidizole gel?
