Rough Surface Exposure after Immediate Implant
Sixty-eight year old healthy man has had multiple implants. He readily accepted immediate implant when the tooth #5 had subgingival fracture of the lingual cusp (Fig.1). A 5x20 mm Tatum screw implant was placed immediately after atraumatic extraction and bone expansion (Fig.2 I). Implant rough surface was exposed buccally and lingually when the implant was placed equigingivally proximally. Two buccal accessory incisions were made. The flap was raised with scoring the periosteum underneath, advanced downward (as shown in Fig.3 arrow) and sutured to the lingual papilla. The buccal aspect of the implant is covered, whereas the lingual rough surface remains partially exposed (Fig.4 arrow), assuming that the palatal mucoperiosteum is tough to advance even with release incisions.
Fig.3 and 4 are taken 1 week postop, whereas Fig.5 and 6 (mirror view) are taken 2 weeks postop.
Fig.7-9 are taken 3.5 months postop. Buccal gingiva appears to have elevated (Fig.8 arrow, as compared to Fig.5 B). The rough surface seems to have been partially covered by lingual gingiva (Fig.9 arrowheads, as compared to Fig.6).
My questions are as follows.
It appears that exposed rough surface causes no harm. Can the lingual margin be placed on the smooth portion of the implant when prepared for crown? Or does the rough surface need to be covered by crown?
How to handle the lingually exposed rough surface intraop for immediate implant? Guided bone regeneration?
Xin Wei, DDS, PhD, MS 1st edition 11/12/2011, last revision 09/19/2012