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Implant Troubleshooting Advice by Dr. Sam Jain-Small sinus tract on 3 yr old implant: any input? Fremont, CA

Implant Troubleshooting Advice by Dr. Sam Jain-Small sinus tract on 3 yr old implant: any input?

implant with fistula
I placed this implant in #9 site [maxillary left cental incisor; 21] 3 years ago in a 32 year old healthy male.  I did  an onlay graft prior to the surgical installation of the implant.  The patient returned for stage 2 uncovery. Radiographically everything looks fine as you can see.  I noticed a small sinus tract on the labial aspect of the cortical plate in the attached gingiva a few millimeters below the occlusal aspect.  He has had no symptoms and did not notice this. I did milk a small amount of exudate from the sinus tract.   My initial thought is to send this off to my periodontist and cover any costs to have this managed whatever that may be.  Any input as to why this would be occuring and what I may be able to do? Any advice would be greatly appreciated.
Implant Troubleshooting Advice by Dr. Sam Jain
Sam Jain DMD says:
You gotta have an in house CT scan.
Primary closure over implants is very often accompanied with fistula like the one mentioned in this case. If you say 3 yrs and then fistula with it, then it is loose screw or food in the hex of cover screw. The fistula would have cause some bone loss of the facial crestal bone.
That’s why I hate primary closures. In this case after the implant placement, the temporary crown should have been placed and if needed some sectg from tubrosity, hugging g the temporary crown.
And a flipper or Essex ……none of that. The temporary has to arise from the fixture. Provide px with good quality of life by putting a temp crown….especially in the front. Cosmetics is excellent, no uncovery surgery, no fistulas, and progressive loading.
Well in this case uncover the implant right away, clean and scrub with IV metro / clinda soaked gauge, make a nice screw retained temp and to avoid the nightmare of recession, place a thick sectg from the tuberosity and let it mature for 6 months. Remember sectg at the uncovery stage is paramount.
CT scan evaluation is must to have a feel of the buccal bone level and thickness.
Sam Jain