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Jedediah posted an update
Two implants were placed. One immediate implant and one implant adjacent on a healed site along with simultaneous ridge augmentation. Implants were covered and primarily closure achieved using PTFE sutures.
This was how the patient presented three weeks post operative for check up and suture removal. What would you do and what are your options??? Please, please, please, leave a comment below so we can all learn together. Once I receive a few comments I will post an update and photos of the case. No wrong comments so let’s go! Leave a comment below👇👇👇
vikas, Dan and 4 others9 Comments-
tell me more, tell me more?
Did you suture it back again? very interested on the outcome.
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Here are some photos of the surgery that day. I’ll update the outcome and what was done once I get a few more comments. Stay tuned.
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How do you decide when to open back up and when to leave it alone and baby it along?
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Irrigate the site to remove any debri, advise patient to maintain the site as clean as possible, put patient on antibiotic (Augmentin) and mouthwash (Chlorhexidine), allow the site to heal with secondaty intention, if we try to suture this again it is going to be messy as it is already inflammed. Follow patient for a post op every week. I think it will heal fine looking at the intra-operative pictues.
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That is definitely one way that you can address the situation. The only thing that I would not recommend using is Chlorhexidine as studies have shown that that can limit some of the healing, or it takes some of the bad stuff away, but the good stuff too that helps the patient heal. Unfortunately, the patient may not like the answer, but often time heals all wounds, and sometimes the best thing that you can do is let biology take care of it overtime. That’s definitely the best option in this case.
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I agree with Apexa, CHX 3x daily and monitor healing in shortened intervals. The real question is why did this happen?
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That is definitely one way that you can address the situation. The only thing that I would not recommend using is Chlorhexidine as studies have shown that that can limit some of the healing, or it takes some of the bad stuff away, but the good stuff too that helps the patient heal. Unfortunately, the patient may not like the answer, but often time heals all wounds, and sometimes the best thing that you can do is let biology take care of it overtime. That’s definitely the best option in this case.
That is a great question. Multiple reasons why this may happen. One looking at my surgical photos I could’ve decorticated the buckle plate much more which is typically what I do with most of my cases but this was a much earlier one, and didn’t do quite as much as I would like. When I suture typically, I have more interlocking which I could’ve done to improve also. Having said that, sometimes everything is done correctly and this patient still does not respond well to treatment that has a great deal of inflammation. We try to control this with antibiotics and dexamethasone amongst others, which definitely can help but sometimes this can occur despite our best efforts.
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Yep I would advise warm water rinsing. I don’t advise CHX in the happen stance it does affect fibroblasts. I’d have pt come back in 3-4 weeks to check soft tissue. I’d also put them on Augmentin 875 mg. The adjacent teeth are clean so I’m confident outcome is good. It’s when OH is poo that I’m worried.
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Yes. Great way to deal with it. Typically I don’t have them do any type of rinsing, even with warm salt water right after surgery if I do growth factors as it can take away some of those benefits. However, several weeks after yes that would be a very good option along with a follow up appointment to three weeks after. Yes you could also precautionary. Give antibiotics at this point if you haven’t dexamethasone which will help reduce inflammation, which will improve discomfort and overall outcome can also be very helpful and beneficial to your patient, or a similar type of glucocorticoid
So yes, all of you had great suggestions and observations, and in this case, letting the body continue to heal and give it more time is definitely the best situation here.
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