Large soft tissue swelling over labial after graft: recommendations?
I have a 47 year old female patient who presented with an implant placed in #8 site by another dentist 8 months prior. He then placed a bone graft and soft tissue graft 6 months after placing the implant. You can see the large soft tissue swelling over the labial of #8. It is painless. What do you think the problem is? What do you recommend that I do?
10 Comments on Large soft tissue swelling over labial after graft: recommendations?
New comments are currently closed for this post.
DrT
3/21/2017
Based on the fact that sutures are still present I will assume the secondary grafting was just done..I would send pt back to dentist who did it. At a minimum I would call him/her to see just what he did, and what antibiotics he used....then I would consider new course of antibiotics. But ideally, I would want the original Doc to handle this.
Dr.Yass
3/22/2017
Thank you for your reply.
New antibiotic course course didn't change anything.
The original doc isn't available to handle his case.
Sam latif
3/21/2017
I would not treat this patient if her dentist is near by, if she moved to your area I would do c scan and you see the cause of the infection , it's possible that the apical portion of the implant perforated the or fractured the buccal plate , then it would remove the implant before extensive bone loss occurs , augmentation of the socket and trim plant after 4-6 months
Good luck.
Dr.Yass
3/22/2017
Thanks for your reply , I almostly used this
Scenario.
And I will follow up and update soon.
Thanks guys.
Chames
3/23/2017
In agreement with you. Happens when flapless placement prevents visual access to buccal plate. Anti inflammatory medications may help but healing may also be considerably delayed. Other eventuality is sequelae from extraction. Your best bet is to open and clean the area then decide in function of the lesion whether you graft over the fixture or graft after removing it. Google luck.
Dr PA
3/22/2017
soft tissue swelling can be part of healing process, any foul odor from the graft?,otherwise graft is looking fine, pt must go back to her old doctor or bring a report of case summary
Dr Bob
3/22/2017
Flap open and look at it something is going wrong. If you have little surgical experience with removing implants and bone grafting then refer the patient. This could be messy surgery.
Carlo
3/22/2017
Aside from the inflammatory/infective concerns, it seems the implant is angulated to the buccal to a degree that could pose restorative concerns.
Maybe this is a good time for removal.
comlan Missih
3/24/2017
Base on the images provided, the sutures from the procedure are still present. I would not rush to do anything if there is no signs of infection. Give the tissue some time to settle in and heal first before jumping to conclusion.
Buccal plate perforation as previously stated could be a possibility but again time will tell
z
3/26/2017
You can still see the donor site on the palate so this is pretty fresh. Looks like a connective tissue graft that got too much tissue growth. If you just slap the tissue on and suture it, that's the result you get. I have had that situation. Some of it shrinks and some of it has to be corrected surgically/gingivoplasty. Better to have too much tissue than not enough. Is there pus that comes out when you press on the tissue? If not, not infected. As long as no pus, not anything to worry about. What's all the crap on the palatal of the implant?
