Risk Factors and Management of Dehiscent Wounds in Implant Dentistry

Risk Factors and Management of Dehiscent Wounds in Implant Dentistry
June 2004
Sadig, Walid BDS, MS*; Almas, Khalid BDS, MScÇƒÜ
Implant Dentistry: Volume 13(2) June 2004 pp 140-147
Lippincott Williams & Wilkins
*Associate Professor/Consultant, Department of Prosthodontic Dental Sciences, King Saud University, College of Dentistry, Riyadh, Kingdom of Saudi Arabia.
Reprint requests and correspondence to: Walid Sadig, BDS, MS, Department of Prosthodontic Dental Sciences, King Saud University, College of Dentistry, P.O. Box 60169, Riyadh 11545, Kingdom of Saudi Arabia, E-mail: walidsadig@hotmail.com
Abstract TOP
Successful implant dentistry is based on adequate training, proper selection of patients, careful surgery, preplanned restorations, and postoperative and supportive care. Although implant therapy is highly successful and predictable, it is not without possible early and/or late complications. The aim of this article is to highlight the importance of a relatively neglected subject of dehiscent wounds in the dental implant literature. This article covers the definitions of wound healing and wound dehiscence and some of the common risk factors related to suture line opening as an immediate postoperative complication. These factors appear to be largely iatrogenic in nature and partly related to patient neglect. Hence, it deserves documentation to confirm a strategy for their avoidance and management. A management protocol is presented on how to deal with different types of dehiscence and causal factors.
Implant dentistry is showing increased acceptance and practice among general practitioners. The percentage of general practitioners who said they surgically place implants increased 50% in just 1 year. 1 Preoperative, intraoperative, and postoperative misadventures are critical factors that determine the healing process and treatment outcome. 2
Wound is defined as an injury to the body caused by physical means. Wound healing refers to the restoration and union of wounded parts. Surgical wound is the wound produced by surgical incision. Open wound is the one that communicates with the atmosphere, whereas septic wound is the one that is infected. 3 Dehiscent wound is equivalent to a splitting wide-open or fissured wound. It is also defined as development of a separation of the layers of a surgical wound, which results in an absence of primary coverage. 4,5
Implant dehiscence is known as premature exposure of the cover screw or mucosal proliferation when the implant head does not remain buried beneath the gingival tissues. There might not be signs of distress or infection, but a distinct implant component, usually the healing cap or cover screw, is seen. 6 This does not indicate failure, and it is not necessarily portentous of loss of the implant. A good chance of achieving osseointegration remains despite this complication. 7
In implant dentistry, during the immediate 10-day postoperative period, incisions sometimes breakdown and the underlying bone or implants, or both, become exposed. 8 Dehiscence of the incisions probably is the most common postoperative complication of implant surgery. 2,8,9
An attempt has been made in this article to review some of the most common risk factors of wound dehiscence in implant therapy. Clinical examples encountered are shown. Emphasis is placed on their avoidance and how to deal with it following
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