14 Responses to “ exposed threads ”

• JBG DDS MAGD MICOI October 13th, 2009

  
  

  Craig, there are several things that come to mind looking at the radiograph provided. The enlarged PDL assoc with the central and cuspid. Is that apical pathology on the central? Is that RMGI on mesial of cuspid and why is it there ( could there be pulpal pathology here as well? )? With that PDL appearance, what is the bite/parafunction in the anterior? What was the bone level like upon placement? Do you have a clinical photo so we can see the tissue morphology? These issues may have already been addressed.If so, I would administer anesthesia and flap that baby and see what I could see and go from there. Best of luck and report back how things go please.

• David Levitt October 13th, 2009

  
  

  Flap it, degranulate it, clean it (w citric acid), graft it, membrane it, close it, pray the patient quits smoking.

• deepak rai October 14th, 2009

  
  

  hi,if you have access to diode laser, i believe after checking adjacent tooth parameters as said by JBG, you can go non surgical, by lasing the soft tissue (810nm) spaced over three sittings at three week intervals.
  also smoking is a concern always in implant case success,try motivating him out of habit,wish you luck

• khalil October 14th, 2009

  
  

  i think the space around the implant is not sufficient, and caused bone resorption???

• Craig October 14th, 2009

  
  

  Hi everyone.
  Thank you for your responses. To answer your questions:
  -There is some parafunction/clenching/bruxism. Patient does wear an occlusal guard.
  -Tissue morphology is WNL.
  -Adjacent teeth test vital to ice.
  -Space around the implant: implant is aproximately 2.0 mm from adjacent teeth at the closest points mesial and distal- this would be considered acceptable
  - what benifit will the diode laser do, other than trim the tissue?

  David, where do you get the citric acid? I have also heard about using tetracycline to cleanse/prepare the implant surface prior to regrafting. Has anyone else heard this?

  Thanks,
  Craig

• dinhdmd October 14th, 2009

  
  

  Craig,
  You can Google for the citric acid. As for me, I like using the tetra more. I just “inherited” several of these case from the previous doc. What I did was- flapped it, degranulated thoroughly, detox with tetra, allograft+ calcium sulfate hemihydrate+ membrane (optional). After 4 months, I place a provisional out of occlusion. Then final restoration after 6 months. Radiographs were taken on monthly basis. So far, I have getting good result. There was 2 cases with relapsed of 2 threads exposed. Lucky, they are in a nonesthetic area. The above is my “protocol”, does anyone else have any recommendation.
  Again, good luck with the tobacco cessation.

• Craig G October 14th, 2009

  
  

  Can you describe how you detox the area with tetracycline? Do you merely disolve a capsule contents in saline? How long do you apply it for?

  Thanks,
  Craig

• Peter Fairbairn October 16th, 2009

  
  

  Hi Craig , not sure where you are as to what materials available but solution 2 is the way as all the others have said , possibly best way to “clean” the implant is a prophy jet (paper by Lang et al May 09) and my mentor who has manufactured implants since 1986 then graft.
  As in the aesthetic zone this can come back to haunt you if not rectified.
  Regards
  Peter

• Craig October 17th, 2009

  
  

  Thank you all for your suggestions.
  I did flap, removed granulation tissue with curretes and Diode Laser.
  The bone fully extended to the platform of the plant even on the facial like a “castle with a moat around it”. This left an ideal defect for grafting. I replaced healing cap with a cover screw. I disinfected with Tetracycline. I placed Dynablast putty in the defect and covered with Biomend extend and Got primary closure.
  Now the prayers……..
  Thanks
  Craig

  ps. Patient also claims she will try and quit smoking

• Mat Papakiritsis October 27th, 2009

  
  

  Dear Graig,
  How is the post reatment condition of this patient?
  I asked you because in past I had to operated similar problem.Uncovered implants threads,thin soft tissue,smoker….

  A flap prepared,Implant surface cleaned with tetracycline solution(a capsule solved in saline)and implant surface rubbed with a cotton swab immersed in above solution.After that autologous bone mixed with tetracycline and placed on implant surface and the first layer of the bone covered with second layer of bone xenograft mixed with tetracycline(second layer prevents the autologous bone resorptioncontacted on implant surface.A resorbable collagen membrane placed and the flap sutured.
  The rsults were good but smoking stop is very critical thing a patient have to do.

  Regards

  Mat

• Craig October 27th, 2009

  
  

  Mat
  post op healing is good. Smoking decreased but not stopped. Time will tell if the bone fills in the defect.
  Thanks
  Craig

• salim shafi October 29th, 2009

  
  

  please ensure that temporary restoration,perhaps flipper or essix is not impinging excessively on this area,again recheck parafunctional habits .

• pfb November 14th, 2009

  
  

  Hi,

  After seing the x-ray, wich is not enough to get an idea one thing come to my mind. The bone resorption only ocurred in the implant. In adjacent teeth the bone is still present. The implant is in good position.

  So anyone consider a surface problem??

  My opinion is that the surface is causing ll the problems, and if so, even with the bone graft after yu expose the implant for the provisionl you will get the same bone resorption. Maybe worst becuse the biomaterial you placed will not have fibers inserting the implant. So you will get resorption to accomodate for the biologic with.

  With this surface problem you will get continuous bone remodeling year after year.

  Hope that this helped,

• osvenezuela January 12th, 2010

  
  

  I treated a similar case of exposed implant threads in the lower premolar area. I lifted a mucoperiosteal flap, removed the granulation tissue, used clorhexidine solution (0.12%) to disinfect, also used tetracycline solution (a capsule of 500mg diluted in saline solution) applied with a cotton pellet and left for minute (tissue will get brown because tetracycline will cause and acid burn), rinsed the tetracycline profusely with saline, grafted with homologous bone, put resorbable membrane and sutured without tension. After about 10 days the membrane was exposed about 3 mm, and I decided not retrieve it but rather instructed the pt clorhexidine mouth rinses 3 times day for 15 days. The wound closed well. After a few months the threads have reappeared. I eliminated the cantilever and smoothed out and polished the exposed implant threads. I repeated the crown. This seems to be working now.

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