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Fistula

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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Replies to This Discussion

Permalink Reply by Henk de Waal on November 11, 2009 at 4:36am
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
Permalink Reply by Cary Feuerman, DMD on November 16, 2009 at 11:12pm
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.
Permalink Reply by Ira N. Dickerman, CDT on December 5, 2009 at 2:39pm
It turns out to be cement. This from a very careful operator. Just goes to show you it can happen to anybody.
Ira
Permalink Reply by Cary Feuerman, DMD on December 5, 2009 at 6:47pm
Not as uncommon as you might think!

Ira N. Dickerman, CDT, TE said:
It turns out to be cement. This from a very careful operator. Just goes to show you it can happen to anybody.
Ira
Permalink Reply by Doug Ness, DDS, ABGD on December 15, 2009 at 12:22am
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.

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