I have a friend who has an anterior implant that was placed and restored by a first rate practitioner. The doc literally works with a microscope. Many months after having the crown placed she has developed a fistula at the apex of the implant. She is on her second course of Amoxycillin and it is not resolving. What can cause this to occur, and no it is not from cement. She did complain of occasional phantom pain after it was finally restored.
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Was this an immediate implant? If so, perhaps there was a periapical lesion that was not adequately curretted prior to the osteotomy.
Surgical access is needed now, just as an apical surgery on a natural tooth. Complete currettage of the lesion, bone graft, etc.
Hi Ira,
Henk has it right. Prior xrays and the history may give insight into the pre-surgical status of the tooth. If there was a prior endo failure or apicoectomy, for example, and the site was not properly curetted at the time of tooth removal, then a contaminant may have remained. You should also check the proximity of the implant to the adjacent teeth apices to see if the teeth may be the source of the problem, i.e.endo problem. Let me know if you need more info. Hope this is useful.
If you could get an old Xray of the tooth just before extracted you will probably find the area in exactly the same place - my guess is the area was not totally cleaned out at tooth removal, or not enough time as given for the area to heal totally. Regards, Hendrik de Waal
Replies
Surgical access is needed now, just as an apical surgery on a natural tooth. Complete currettage of the lesion, bone graft, etc.
Ira N. Dickerman, CDT, TE said:
Ira
Henk has it right. Prior xrays and the history may give insight into the pre-surgical status of the tooth. If there was a prior endo failure or apicoectomy, for example, and the site was not properly curetted at the time of tooth removal, then a contaminant may have remained. You should also check the proximity of the implant to the adjacent teeth apices to see if the teeth may be the source of the problem, i.e.endo problem. Let me know if you need more info. Hope this is useful.