JIACD
The Journal of Implant & Advanced Clinical Dentistry
How would one treat thread exposure of an implant in the aesthetic zone after loading?
Thu, 08/20/2009 - 10:03 — Richard Hughes DDS
How would one treat the exposure of threads (3 to 6 etc) on the facial aspect which appears one yr. after loading? The implant is well integrated, does not need to be removed, machine surface, 4.2 X 14 mm. rootform, occlusal adjustments have been made and is under control.
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Comments
Thread exposure treatment suggestions
Having 3-6 threads exposed on the facial aspect 1 year after loading sounds like a planning issue. I would be willing to bet that when the implant was placed, there was indeed some bone on the facial aspect but it was probably thin. Best treatment may have been to augment the bone first and then place the implant. This is why many are shying away from immediate implants in the anterior. Even with bone grafting, many are finding this exact situation...the facial bone dissolves away after loading and you are left with an esthetic problem.
Anyway, back to your question, if you have 3-6 threads exposed, you are going to need to do some GBR. In order to do some GBR, you are going to need some soft tissue to cover your graft. This is a challenging situation. Without seeing the case, I would be thinking about a lateral pedicle to preserve blood supply to the soft tissue followed by particulate GBR. You may even consider removing the implant crown, resubmerging the implant during healing, and uncover again later. It all depends on what your case looks like.
Hope this helps.
management of thread exposure
Most likely the thread exposure is due to a very thin buccal plate at placement. This can happen when immediate implants are placed as the implant in these cases needs to be placed to the palate leaving a gap between the socket wall and implant which will fill with clot and form bone. when the implant is placed contacting the and the resulting micropressure causes resorption.
I would recommend flapping the area clean the threads with a doxy paste (not on bone) for 15 sec then rinse, place a pellet soaked in citric acid over the implant threads and bone for 30 sec rinse. (the Meffert technique) then place regeneform graft material over the area place a peice of Zimmers Puros Dermis and get good closure and prey
Thread Exposure Management
I agree with Tidoc suggestion but I would treat the implant surface as Dr Kurtz suggested.I would remove the crown, resubmerge the implant with a connective tissue graft instead; depending on which area on the anterior and the status of the adjacent teeth make a provisional 3-unit bridge, a Maryland bridge or a mesial or distal cantilever. However if the implant was placed a too buccal it might be a little bit of a challenge to cover those exposed threads.
Treating implant recession
I would remove the crown, resubmerge the implant with a connective tissue graft. I would detox the implant surface first and place a bone graft over it then add the CTG.
Baxter
Connective tissue graft the implant.
Do a connective tissue graft.
Implant recesssion: Alloderm works well.
CTG or Alloderm works well in these cases.
Implant failing.
Do a CT Scan....I bet the implant is failing and needs to come out.
Thread exposure--Remove the implant - grafting doesnt work
Grafting of implant implant dont work. The bacteria prevents it.
Having had some implant
Having had some implant cases with threads exposed for 15 years in a stable situation I feel it is not imprerative to remove but assess case to case . As for re-grafting this too is possible by removing all granulation tissue , prophy jet cleaning the implant surface the using synthetic graft materials which are fully "turned over"that is bio-absorbed.We can achieve a certain amount of bone regeneration . Then polish the threads at the top to aid soft tissue outcome.
The size of the threads and the depth of the blasted surface can be critical in these cases in obtaining results.
Not totally predictable but have had many good results ove rthe last 7 or 8 years.
Peter
Peter I agree but long term the implant is going to fail
Exposed implant threads leads to failure. You cant detoxify and more bone loss is coming. Remove the implant and start over I say.
Paulov
Over the next 20 years ,
Over the next 20 years , there are many factores involved as I said the surface and the size of thread being the most important in this loss as well as patient prevelance to certain bacteria.
But as far as I can see the exposure of a thread or two generally does not lead to the loss of the implant in the last 20 years or so of placing .
In fact many implants have a small exposure of buccal threadss and it has no effect on the long term stability.
The current trend of placing deeper to lessen the chance of thread exposure oddly may in fact lead to bigger issues ( especially in the aesthetic zone) in the long term , which we may find to be the case in the future.
If we removed all implants with a thread exposed we would spend more time taking implants out than putting them in.
The Korean reverse torque ( 400 Nm ) appliance will be a popular buy then.
Regards
Peter