JIACD
The Journal of Implant & Advanced Clinical Dentistry
Infection question: How would you handle this clinical situation?
Wed, 10/07/2009 - 08:05 — drg
Here is situation I have:
tooth # 3 has an endo and crown connected to crown on tooth #4. the MB root is resorbed and there's a 10 mm pocket with puss on probing. tooth is asimpthomatic.
what would you recomend-
1.extraction,daiod laser,immediate implant and graft
2.the above without the implant
3.other
thanks
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Comments
Infection question:Here is what I would do.
Without seeing a radiograph its hard to say. If there is good remaining bone around the other roots of 3 you could do a MB root amp.
But in this case I would extract, no laser, clean out socket with debridement, saline. I would graft with BioOss or FDBA and delay placement of implant for 3-4 months.
You probably need a sinus lift as well.
I am not sure why you would
I am not sure why you would use a diode or any laser in this clinical situation.
Section the FPD at the distal of #4. Flap and extract #3 and thoroughly curette all soft tissue from the socket. Evaluate the topography of the bony defect. Graft with FDBA hydrated with saline or 50mg/mL TCN. Cover with resorbable membrane. Close and cover exposed membrane area at socket oroface with collagen sponge. Allow 5 months healing, then place the implant.
You could place an immediate implant too if you have sufficient bone in the septum of #3 to stabilize. Studies done by Lindeboom and also by Shabahang found no negative effect in placing immediate implants into previously infected sites, provided they were thorougly debrided at the time of extraction.
For me I usually prefer to develop the site first, then place the implant. From the patient's perspective waiting an extra 4-5 months for a more predictable result than an immediate placement that will last the rest of their life isn't much to ask.
Nick
Diplomate, ABP.
infections and immediate implant placement
I would not recommend placement of an implant into a site that has active infection. best to extract currette the site place on antibiotics and give it 6 weeks before placing the implant. I would fill the socket with graft mixed with doxy so that you can maintain the crestal bone level.
Good information, thank you.
Good information, thank you.
All comments good. I would probably do the same.
No need to push the envelope here. Bone at this site is probably type 4. Add in the endo infection and you have a poor site for an immediate. I would remove, degranulate, graft, allow to heal, and come back later.