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First complication
Hey, I’m new here so I thought I would kick off the ‘complications’ with one that I have right now. I placed a Biohorizon implant at #12 around 6 months ago and restored with a tibase and emax crown. I’m new to implants so no implant expert by any means, but this seems like quite a bit of bone loss to already have at this stage. Sorry I dont have the original placement PA but at time of placement it was slightly subcrestal, cover screw placed and sutured. At the time of scanning for the restoration I noticed a pin point opening over the coverscrew before we uncovered to scan. At placement I tried to use the implant pathway protocol exactly, all recommended Rx, chilled saline etc. What are your thoughts on the case and what would you do if you were me in this scenario?
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This discussion was modified 1 year, 10 months ago by
Jeremy.
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This discussion was modified 1 year, 10 months ago by
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12 Replies
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Hard to say without the original CBCT, it’s possible the crestal portion where the bone loss occured did not satisfy the biologic requirements of implants (1.5mm buccal 1.0mm lingual thickness) and the bone died from poor vascularization. If the gums are healthy and firm and no inflammation i would just watch and monitor and let patient know it appears some of the bone did not heal around the top of the implant but you will monitor
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Hey Jeremy, thanks for popping this question on here. We actually discussed your case pretty thoroughly today in the latter half of our Coffee & Case Review session. We should be able to get that video up early next week.
However, I can definitely sympathize with your situation. Do you have any additional radiographs? Can you tell us a little bit about the bucco-lingual bone width?
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Thanks again for all the input, where could I find the recording of that case review zoom call?
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Thanks yall, a couple of follow up questions if thats ok. At what point would you decide you can’t monitor it anymore and need to intervene? And, what would cause the pin point opening/what would you do if you saw that during healing? My flap was palatal and covered the implant fully so I figured it wouldn’t be due to incomplete incision closure but ????♂️
I do have more x rays that I’ll attach here.
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Great questions.
1. At what point do you intervene?
I intervene if this seems to be progressing and if the soft tissue around the implant seems unhealthy. If its red, oozing, irritated, then something has to change. However, if the tissue is pink and looks like has no issues, and the bone level seems to not be changing (assuming you have already checked for other things such as occlusion, patient health, etc) then it can be left alone.
However, if it does seem progressive or irritated, I would take action.
The thing is, those exposed threads are rough titanium and are likely to gather granulation tissue around it that is tough to get healthy. That’s why some people opt for something called “implantoplasty” for these types of situations.
However you must first remove the granulation tissue. My preferred tool to remove the granulation tissue is something called and i-brush or r-brush which goes on to an implant handpiece and can be used to pretty effectively remove it.
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2. Why does the pinpoint exposure happen?
I cant say with 100% certainty. But I can guess at it.
Once possibility is that you had something that was harboring debris within your surgical site. I see this happen for example when a cover screw is lost early and the inner implant chamber becomes a plaque trap. Soft tissues don’t heal well when there is bacteria traped underneath.
Another possible factor is that the soft tissue was very thin. When it’s thin, it can sometimes not heal properly over the implants and these pinpoint exposures are very common in those scenarios.
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Hey Jeremy, how did ya end up dealing with this case?
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I saw him again and the tissue health looked good, no bleeding or oozing. I basically reinformed him whats going on and that we want to monitor it closely and watch for changes. We did verify correct occlusion and contacts and got a night guard made for him.
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That’s great to hear! I would definitely reinforce the the OHI and put the patient on a more frequent follow up schedule. Although the bone loss is controlled at this point, we do have to keep in mind that implants with exposed threads do have a higher risk for peri-implantitis in the future.
I’m glad to hear it didnt get worse!
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Hey Jeremy! Sorry for the delay in the post. We’ll be sure to post it up in the video library by tomorrow! 🙂 @erickimplantninja
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Here it is Jeremy. Your case was discussed at the 20 minute mark: https://library.implantninjadojo.ue1.rapydapps.cloud/video/coffee-and-case-review-with-steven-vorholt-episode-3/
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Hi Jeremy – great case and good insight, Ivan!
From a boards perspective (because I’ve dealt with them here in Texas), I would make sure you document everything and do perio charting to cover yourself. Just as my professor in dental school often repeated: if it’s not in the note, it never happened!
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