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.

Comments

Sun, 08/30/2009 - 11:21 — Ti Doc

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.

Mon, 12/14/2009 - 18:15 — Gregori M Kurtz...

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

Mon, 01/11/2010 - 20:01 — Sammy Noumbissi...

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.

Thu, 07/01/2010 - 15:17 — G Baxter