A Fistula after Implant is Loaded
Dear Dr. Cai
Does the earthquake affect your family? If there is enough space, place bracket to save hassles. You have to remove the metal button later on.
Robert: After reviewing X-ray, my impression is that the implant with radiolucency needs to be removed, the osteotomy thoroughly debrided and a larger implant placed immediately. In addition, place one or two regular implants next to the infected implant. Bury implant(s) if primary stability is not high. The possible reason of the failure is overloading. Did you load these two implants immediately? Did you soft reline the denture immediately or relieve the denture tissue side enough? Take CT before surgery. Thanks.
Bob: Thanks for nice presentation with attachment. You asked a good question. It appears that the radiolucency does not decrease as compared to 1 month follow up. Even though the clinical sign improves, the right implant will be fibrointegrated at the best. If I were you, I would open up soon. If bone is healthy around the implant, remove granulation tissue if present. If it looks bad, remove the implant and place a larger one if walls are intact. Pack bone graft and place a collagen membrane. I would place an extra implant as a bonus for the patient and punishment on myself so that I would never forget. Premedicate the patient. Make an incision so that you may extend it later if necessary for the bonus.
As you are aware, I am not satisfied with X-ray taken by your assistants. Three PAs for this case do not show implant threads. It suggests that X-ray is not taken parallel. Your implant may unexpectedly heal, but the X-ray may not. You have to do something. Find X-ray book and read the first few chapters, particularly how to take X-ray: parallelism. Thanks. 2nd you have to write down insertion torque # when finishing a case. In case if fails, you may figure out why.
Xin Wei, DDS, PhD, MS 1st edition 03/29/2014, last revision 04/18/2014