Fistula after implant placement-part 2

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Posted on By Cristian Rotaru In Failures

This is a follow up of the case i posted 2 days ago, see related post.
This is one way of managing this complication, the other one is to fully explant.
After 18 months the ISQ shows 79 and the tissues are healthy with no signs of inflamation.
Thoughts and questions are welcomed.

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18 months recall


Cristian, really nice result and clean surgery.
I`ve done implant apicoectomy in several occasions and have good results, too. Those implants were already in function for some time. But somehow if an implant shows a problem at start (and before start) I prefer to take it out. Like if the patient spends a money and time for implants, it is fair to start with healthy situation.
But - only a change is permanent and we all learn from each other. A small surgical intervention to save an implant, if predictable, is less invasive than implant extraction - augmentation - implant placement.
Thank you for sharing this important issue
Best regards


Hi, Snjezana . Thank you !
When i started the surgery i was determined to take the implant out and start all over.
But when i reflected the flap, cleaned the inflamatory tissue and sounded a little around the apex of the implant, i started thinking of trying to save the rest of the implant that seemed ok.
The implant appeared stable enough after 4 months to try this.
I am not saying that this is the way to go, maybe i got lucky here, but is a viable alternative( thats why i waited for a year and a half before showing this) to taking the implant out.
I believe that taking this wide diameter implant out, with half of it oseointegrated, would result in a prolonged treatment time for patient and more surgical interventions. If this implant would fail in the end, than i will replace it with another one .

But why do you think this happened in your situation also ? You said your implants were already in function for some time when this happened , so what could cause this ?
Have you also experienced this in wide diameter implants ?


Hi, Cristian,

your approach seems very logical to me.
I am honest when I say that none of four implants where I performed apicoectomy was placed by me (I have my failures, but since now not with this problem). All those implants were in mandibula, the bone was very dense and I presume that the bone was overheated.
I believe that apical areas were present earlier, but not recognized or ignored.
Only for one of those implants I have seen X ray taken before implant uncovering procedure. Translucent area was already there, but my colleague hasn`t seen it.
As for your case....if it was over-compression I would expect translucent zone all around implant. Residual infection, flapless approach, contaminated tip of implant (how often it touches a beard hear...)?
Best regards


I believe that in my case it happened because of implant contamination or maybe some residual cells from previous infection in that area.
In your cases maybe the issue was the hard dense bone of the implant and bad management of the situation with overtorquing and overheating, as you also said.

Thank you again for sharing your opinion on this matter !


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