Sameer Puri I wanted to start a discussion on this case. Many of you know this individual and she was going to be our patient in the upcoming Live Implant Seminar in May. A bit of background, this patient had an existing root canaled tooth on #7. Here is the preoperative clinical situation:
There was a vertical root fracture and the tooth was going to be lost. The patient had the tooth extracted and implant placed after a surgical guide was fabricated for the patient after we did the integration between the CEREC and the Galileos. After implant placement by the local periodontist- the patient presented back to the office for provisionalization. We figured the best way to provisionalize immediately post surgery was to bond in a single wing maryland bridge as the surgeon felt the implant was not stable enough to support an immediate restoration. The Maryland bridge was bonded wiht a single wing so as to allow the patient clensibility of the area and satisfy her esthetic needs:
Well unfortunately this case didnt last long. Soon after the initial implant placement, the implant was lost due to pain and infection. The implant was removed and the area was grafted and a new maryland bridge placed. Fast forward to today as Im getting ready for the May Live Patient Implant seminar and doing the prep work. I took a follow up photo and this is what I see and I sent to Farhad:
Its been several months yet the area is still not healed. There is irritation at the tissue and to complicate things further, the patient is pregnant so taking an xray is not an option currently.
So my question to you all is - how would you handle this in your offices? Unless this resolves in a few weeks, the patient will not be our patient for the implant seminar and I will get a new patient. But I figured this would be a good case for discussion among the group. If we dont use her in May, we can use her in the fall seminar.
Regardless, all of this will be covered in the seminar including how to fabricate the maryland bridge, how to fabricate a screw retained provisional and really every step of the implant process. But I figured it would be a great topic to stir up some discussion and talk about the potential complications of implant surgery and more importantly how to manage these complications.
Im sure Farhad will chime in here but Id love to get a vast array of opinions.
- Would you place an immediate implant after extracting #7?
- Would you be comfortable loading the implant? What is your criteria on whether to load immediately or wait?
- How would you handle the complication of having to have the implant removed? how long would you wait to place a new implant?
- If you saw the tissue that you saw in the final photo- what would your next step be?
I think we learn more from failures than from successes. Im hoping this can be one of those instances.
