The problem with dehiscences in the esthetic zone

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Posted on By Thanos Ntounis In Anterior/Esthetic

Young female presents in the office complaining about discomfort in the facial vestibule of #8. Clinical exam reveals normal PDs , lack of BOP and erythema and edema. An implant is placed on area of #8 in a reasonable prosthetic position. #7 was endodontically cleared.

What would be your approach? Would you start over? is the periosteum rubbing on the dehisced implant responsible for patient's symptoms?

I decided to revert to a modified sausage and avoid removing since there was lack of infections signs and pt already had restoration. Pt has been symptom free for the past 3 months.

Initial
CBCT

EDTA applied
autogenous&allograft


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5 Comments

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Reply

Hi Thanos, what a common problem you have. Ask the patient how long has she the implant? This is a very usual finding, the image of the implant "out" of the bone frame, due to buccal resoprtion. I guess it was an immediate implant type I socket.
Good luck. And well done!
Regards
Jorg


Reply

Thank you Jorge! According to dentist who placed the implant was not an immediate... I felt it would be better to just graft instead of remove. See you in NYU!


Reply

Thanos,

few questions- do you know the length and diameter of the implant? If appears that there is a long prosthetic connection ? Did you treat the implant surface? By chance did you examine the overlying periosteum ?
Thanks for your post

Cheers,

Richard


Reply

Hello Richard!
1. Implant is a Straumann BL 4.1 x 10 mm I believe. I am attaching a PA
2. Implant surface treated with Prefgel. Please mind you that I do not consider the implant surface contaminated. In my mind this is not a peri-implantitis lesion.
3. Exam of the overlying peri-osteum did not reveal anything abnormal. I am just curious how other practitioners would approach this.

PA


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