Dr Chan Dave
“Rescuing a sticking-out-implant, by soft tissue management”
Background:
Miss KWW, 72 years old lady, came to our perio master student clinic and complained about foul smell on the labial area on 11 implant. Upon history taking, we noticed that the implant was done back on 2005, and “buccal bone perforation was noted, DBM was added on the buccal perforation site.” There is a “small fistula noted on labial surface of 11 implant” since Sept, 2008. Upon reviews ongoing, the fistula on 11 labial area persisted and patient was advised that “no bone augmentation could be done” by oral surgeon.
i/o:
Upon intra oral examination, 11 buccal fistula was noticed, and pus and plaque can be found on the fistula. It was around 5-7mm above the gingival margin and implant surface can be seen clearly.
Patient had taken a CBCT in the same visit, and showed that the implant was located out of the bone and both buccal side and apical area of implant was out of the envelope.
T(x):
Laterally moved, coronally advanced flap was attempted (Zucchelli et al. 2005). Details please see photos.
Patient was reviewed for more than 6 months with photos and outcome is as follows.
P.S. The difficulty of the case is the sticking out position of the implant, and root coverage procedures around implant will have compromised blood supply.
