Threads Exposed After Dental Implants Placed in Diabetic Patient: Prognosis?

I can't answer your first question because you did not mention how many threads are exposed. Is the implant integrated? Is there supporation? What does the soft tissue look like? What type of prosthesis are you making? Regarding your second question, if diabetes is controlled there should be no increased risk of complications. What is your patient's HbA1C level?

Was the patient wearing an interim prosthesis? Did you place a soft liner?

Yes the first question is about how controlled DM is, or the Hgb A1c, but also if there is other co-morbid diseases, medications taken, why this patient lost their teeth from the beginning, the status of oral hygiene, were the wright diameters of implants used, what kind of interim prosthesis used, I see the angulation slightly off, then was the correct interim prosthesis fabricated eright or not, I had a similar case, but the threads started being exposed at least 6 months after uncovering and loading the implants, but my patient had DM, kidney disease

Was it an immediate placement, If so you may have lost the buccal plates, and hence this would have happened in any patient. Have you got a thick band of keratenised tissue? if yes, and the patient is not really aesthetically conscious then you are not really in trouble at all. Just manage the case prostheticly, by polishing the threads and making 3 separate bridges and possibly prepping the implant itself in the areas of exposed threads, finishing the restoration here (only do this anteriorly and use Ucla abutments on the distal implant to correct the angulations) If not I think you really need to think about regenerative surgery. In a diabetic, you may want to do it the safe way, by getting 1º closure over the implants, letting it heal and then placing a CTG over the areas of concern in a 2º procedure. Then waiting for it all to settle. If you have to pull the tissue up to cover big defects you may need to do a tertiary vestibuloplasty procedure in the end. It will add many months to the procedure time, and you may need to fix up a temp using the unaffected implants in this time. However, the patient is only 50 and if there is a keratenised tissue problem, then he will have issues down the line. Just explain it all to the patient, shit happens and you know how to deal with it, and it'll all be ok in the end! Good luck.

How many threads are showing and what type of surface are we dealing with. If it is a machined surface, I wouldn't fret. If it is a Ti-unite type surface that is exposed, then the chances of being able to maintain the implant goes lower. Is there attached gingiva around the exposed surface or is there only unattached gingiva. If there is no attached gingiva,then my recommendation is to do a connective tissue graft to make the tissue less mobile and therefore more maintainable and less of a plaque trap. As far as controlled Diabetics: they are like you and me so treat them like they are a healthy patient...unless their HbA1c takes a hit.

Dear Dr as you have already mentioned that it is a case of controlled diabetes, probability of infection in this case is nil.Use of soft tissue graft to submerge the threads cud be advisable and post prosthetic plaque control should be scrupulous because any sort of perimplant disease then can cause reexposure of the threads with tissue recession or pocketing

dear friend.Obviously this is a compromised case selection as well as performance, guided planning and implementation were obligatory un such a case, nevertheless since Ihave doubts about the two distal implants i'd recommend that you wait until full oseointegration be established."Better worry then sorry ". GOOD LUCK

Dear Dr In regards to the suggestion of prepping the implant, be aware that should that implant fail for any reason you will be giving fuel to the plaintiffs attorney. TMG

1. Soft Tissue graft will not increase bone-level. 2. Since only 'some' threads were exposed and not all,(ie meaning no threads were exposed on some implants) I wouldn't even worry about the diabetes being the reason. 3. Assuming no final prosthesis has been inserted since it's only been 3 months, exposed threads are not due to loading/angulation problems. 4. What was the reason of his teeth/tooth-loss? If it's RCT/infection, then the surrounding bones are in question regardless however long ago it was removed. Compromised bone is compromised bone. 5.Implantology is NOT a for sure thing, you can do whatever planning you want, if it doesn't integrate, leaving it in there longer will not help it integrate. 6. Remove the implants if it's mobile and/or symptomatic.

Post op residual bone loss is related to the amount of bucco-lingual bone ,so when bone loss was encountered it is highley unpredictable to achieve bone . One thing can be done to improve prognosis is pre-treatment planning making sure enough bone present before implant placement Other thing is improve soft tissue by confirming enough attach gingiva present or if neede should be grafted.good luck

All good points. In cases like this sometimes you have to look at the pragmatic solutions. Suppose that the threads became exposed due to physiological bone remodeling post extraction. A couple of well integrated implants have a couple of threads showing- does this affect longterm out look assuming the presence of keratenised tissue? I do agree that polishing an implant surface and placing a compromised restoration is not ideal, but if it satisfies the patient and gives a predictable long term result,in a non aesthetic area, is it really a problem? Prepping an implant I know and definitely agree is a bit of an extreme thing to do, but is it more extreme and less predictable than trephining a fully integrated implant out and placing another? I don't pretend to know the answer, but given the opportunity I know what i would have done in my own mouth so long as the restorations could be made well. The question is what are we aiming for? If we can achieve a good result for the patent using prosthetic means, rather than surgical and they are fully informed as to the options, then I can not see a problem. I'm just trying to give a couple of low impact practical solutions which can be used as a get out of jail. They do of course, however depend on the implants being sound in all other respects. All the best, Mike

I agree with previous message. I think that you have bone loss because you did not had anough bone bucco- lingually. for good bone support you must have 2 mm of bone buccaly in order to prevent resorption. I don't think the proble is diabetes. I placed many implants in diabetec patients and nad no problem. Another problem may be because of implant design. Many people may not agree to this but this is true. What kind of implants is this? This looks like IMTEC-Endure whide implants. If you have this implants then you will get bone loss all around micro thread. So, that also could be a problem. Other reasons: Is this immediate placement? Did you load these impalnts? did you used soft reline? The most common problem is bucco-lingual bone, must be at least 2mm to prevent resorbtion. Why did you place that wide implants in anterior region? There is nothing you can do to restore bone back. Looks like you have bone loss not just buccaly but all around the implant. The only why will be to remove the implant and place again later. Otherwise if implant integrated you may keep it. Its all depends what type of restoration you wil use. I wish you luck.