Membrane Lost and Cover Screw is Visible on Camlog Implant: Recommendations?

hi- a few questions- 1. why did you need a membrane to cover the crestal area of the implant? if you were augmenting bucally i can see why you would use a membrane, but if you were not in an an extraction socket, why did you need a membrane?? it does not look like an immediate procedure from your picture. how long ago was tooth taken out??? a summer's technique does not need a membrane unless you have augmented somewhere else. please explain 2. why didn't you place a healing abutment at time of surgery?? Did you have enough primary stability - you most likely did with a 6.0 diameter fixture. you could leave this the way it is. your tissue will be a bit deficient in the area but you will be okay as esthetics won't be a problem. you could also place a healing abutment now (lightly tightened) - this would help close the wound a bit, aid in wound hygiene, and prevent a second procedure. please tell us the rational for the membrane and i can give you a better answer.

totally agree with the last post, i would fit a healing abutment to tidy up the tissue margins and also avoid 2nd surgery. all should be well providing the patient does their bit (heal up) and also mantain good hygiene. lee

Thanks for the responses.Tooth was extracted 8 months ago. I had grafted buccally and as I had used osteotome to condense bone primary closure was going to be difficult and thought with membrane coverage tissue healing would be fine.Primary stability of implant was good but did not feel comfortable placing healing abutment as this is my first maxillary summers lift implant placement.

Just leave it alone.

Just leave it, and it should granulate in just fine. Judging from the second picture, your sutures are under too much tension, as the gingiva is clearly blanching everywhere you have a suture. Also, consider a monofilament suture, such as nylon (thinner is better) or PTFE from Cytoplast.

Dear Dr. RP, I think your implant will be fine. I just want to point out a few surgical principles that may be of help to you: 1. Almost never attempt to re-suture a dehisced wound. It will not work unless you de-epithelize the wound margins, which is difficult to do. 2. It is ok to add a membrane, however you need to release the periosteom to allow for primary closure. Otherwise your membrane will be exposed, will resorb too soon, and will harbor intraoral bacteria which can lead to an infection. In addition, the membrane will not speed up the healing, to the contrary, it will compromise the blood supply and will slow down the healing. 3. Prescribe antibiotics whenever you graft a foreign material (i.e. bone, membrane). Good luck.

For future I would recommend you to try to have release incision made to gain more tissue and gain primary closure. Also use mattress suture technique that will keep tissue closed and prevent membrane loss. The photo show that you had enough attached tissue there, so that could be achieved easy. In your situation now I would suggest to remove the implant, let that tissue heal, then place new implant, graft area, and use the above techniques for tissue gain and suturing. Remember if tissue open you increasing the risk of bone lose.

What are the applications of platelet rich fibrin membrane in this situation?

Do not remove the implant. Even if the cover screw is exposed (it was good that you posted a picture and a radiograph)it will heal and you'll be surprised at how much te tissue will granulate over the cover screw. You did not need a membrane for this case if you had released the periosteum at the base of the flap like periodontist mentioned. That would have given you a tension-free adaptation of the flap margins and adding mattress sutures to your interrupted sutures technique would have prevented flap dehiscence. Give it time and it should be a successful implant. Good Luck!

am i right in assuming that you placed a crestal incision ?? Did you plan to graft before - if you had -- then you should have placed a more remote incision. Periosteal release is always good - your suturing is under too much tension. If you leave this it will heal - do not remove the implant.

Do not remove the implant,keep the antibiotics 14 to 21 days after surgery, and give to him a pos-surgical brush with a clorehexedine 0.12% to keep the place clean, and see the pacient every three days,to verify the infection or granulation tissue and clean the area

Dr Amayev is from the Planet Lala. Why on earth would you do that? Leave it alone and chill.

Thanks everyone. Pt. was put on antibiotics and follow up shows good healing.Will leave it alone for complete healing.

I don't know what planet you from???? But this is opinion and treating approach of every dentist. I you taken a chances GOOD LUCK. I don't waste my time and patient time. I don't want to wait for 5 or 6 month and do the work over again and let my patient wait for the year or more. I placed more than thousand of implants and I saw many complications and I try to avoid them and taken a chances. Why nobody mention about loss of membrane and graft. The all responses only suggest to keep the implant and wait, but what about the bucal part of the implant that exposed??? The reason I suggest to remove implant is because as I understood the implant was grafted bucally ( so there was no bone supporting implant), it also was mentioned that the membrane was lost. If the membrane was lost during this short period (7 days) of time it means that the graft wouldn't be there Right? So why keeping the implant if the buccal part of the implant not in the bone and exposed??? also tissue dehiscence present. That will cause more bone loss. Don't you think that by removing implant then graft the area and placing the implant again wouldn't be the best idea???? To treating dentist: if what you do and it heals properly I will be only happy for you. You should treat this case way you feel is right. The second time when you do similar case I am sure you will know how to handle from the beginning. Make sure you use proper suturing techniques and use the release flap technique to have primary closure and avoid tissue disruption. All the best.

Dear colleague; I would like to suggest that you need to take a course in GBR & GTR befor you attemt to do that. If you would place an implant of 5 mm wide is enough,not 6 when you are not that expert in GBR. If you had a small dehiscence, then just prescribing antibiotics & CHX 0.12% is enough ,but w/ soft tissue problem that w/ a pouch technique place a CT graft. But if you had a one wall deffect, then you will end up w/ a disaster afterwards......

Dear dr Please never attempt to re suture,remove excessive soft tissue over the cover sq and expose total c s. and order the patinet to pour bi carbonate NA over the c s every night to enhance localPH to prevention bone loss.And want from patient to clean that untile no plaque cver the cover s.....u will get good res Bahram.marzbani(iran)

Once again Dr.Boudet is I believe correct in his assessment and advice. A few are talking about a buccal graft but from what I can see and understand there was no buccal graft but only a very small crestal sinus lift. I think the case will turn out fine in spite of the exposure.

I would leave the implant alone at this point - looks like it will heal. However, I think it is much too short. I never put anything less than 5x11mm in the posterior maxilla. If you are going to place in the posterior sinus you must be able to do lateral lifts. Summers lifts are unreliable. If you have 6mm of bone or less and can't do a lateral lift refer it out for a graft. Place at least an 11 and longer is better. d4 bone is weak

Do not use CHX 0.12% on any open wound, it will delay healing.

I respectfully disagree with LD Singer. Summers technique for sinus elevation is reliable and predictable. If you have at least 5 mm of residual bone height for primary stability you can easily achieve 5 mm plus of graft material with good surgical technique. A recent meta-analysis in J Perio showed that there is no significant difference of survival rates between 10 mm implants and longer implants.

Hi, i think yes a relieving incision woudl have been good fro primary closure. Never re-suture a broken down wound treat palliatively with chx .2% rinse 4-5 times daily and have regular reviews until teh area has healed enough to place a transmucosal abutment; which is much easier to clean. Also dont use silk sutures the attract bacteria-caise 'knitting' -which may or may not effect teh final outcome. Take an x ray on abutemnt connection and then review 1, 3,6 ,12 mnonths (annual radiograph) and take regular probing depths also. Should be fine Regards Tom Booth BDS Hons MSc Dip Implant (pending!!!)