Bone Deteriorating Around Dental Implant

need much more information to answer your questions. Your correct in being cautious. Find out a true diagnosis before retreating.

Bone loss around implants and/or teeth does not "spread" unless what has caused the problem exists in other areas also. Without more details, implant failure after osteointegration is due to poor hygiene or overloading.

could this bone loss be due to a microgap bacterial concern???

Stan, we need more information to answer your question. Were the implants splinted? Is there an occlusal interference (overloading) problem on this implant? Was the bone volume adequate at the time this particular implant was placed? To many variables to pin point your problem. This cannot be determined without an exam.

Hi there, Thanks very much for your responses. I will ask my dentist for more information and post it. But, first, can you please explain what you mean by “overloading” and “splinted”? Thanks.

I have been placing and restoring implants for 40 years. I recently have had 3 cases with widespread bone loss over 6 to 8 implants with a bar overdenture. I agree with the above comments. However If the patient has a history of periodontal disease, smoking, diabetes, high blood sugar, drug use, some medications such as the biphosphenates, etc., expect problems such as this. I am beginning to think that we rarely have the opportunity to place implants into a perfectly healthy patient. There is always some degree of health problem. I think we need to start thinking about how we get away with what we do in the mouth rather than expecting every case to be a miracle and inform the patient, we are going to have problems. Harold Bergman

Need more information. Overloading could be the culprit. I have seen cases where residual cement was the problem. Perhaps it was placed in a site that needed grafting. The microgap is not the cause of rapid bone loss. Once the implant integrates start to look at prosthetic issues. Too little info to diagnose...sorry

First, the bone loss about one implant will not cause bone loss about the other implants. The other respones above are correct, we need more infprmation. There are a number factors that may help the bone loss to get worse, but the number cause of tooth loss is bacterial. The number one cause of bone loss and implant loss after loading is also bacterial. I would look at the location microgap, it be the main cause.

The real cause of causes is the powerful gravity, than insufficiently balanced restoration in a diminished intra-oral space, ill tongue posture, certain premature occlusial contact, bone loss, gap development and only after all of this pore hygiene and infection. Can it spread? It may. It depends on degree of gravity satisfaction. For prevention of this kind of complications every implant case need to be prepared before loading with restorations.

Trauma from Surgery ( e.g. Periosteal Reflection) Smoking Hormonal Disorders High C/I Ratio Low Bone Quality or Lesser Bone Density (D3 & D4) Dynamic Load versus Static Load (Loose abutments or ill fitting restorations) Fixtures with close proximity to Cantilevers Occlusal Trauma (Overload or Biomechanical Stress) Establishment of an increased Biologic Width.(normal 2mm epi. &1.5mm conn.) Plaque Accumulation and Bacterial Invasion Level of Microgap between Abutment and Fixture Autoimmune Response and Cytokine Release (Controversial) Crushing of Marginal Bone and Microfractures due to Installation Stress of Self -Tapping Implants. Not enough space between two implants or/ an implant and natural tooth. IMPLANT DESIGN : ( Crestal Modul not Divergnt and/or Polished Collar) These are all causes of bone loss around implant necks.Check it out.

Comment to Harold Bergman; I have been placing implants almost as long as yourself, and occasionally am surprized and disappointed in what seemed to be an ideal case gone bad. I am starting to believe that granulomatous cells that may have developed due to an endodontic infection, periodontal disease,etc...may remain dormant for a time and then come to haunt us again. Meticulous scraping, cleaning the site with citric acid and antibiotics,grafting, etc., may seem to help in the short run, but I do not believe there is any literature support the fact that 100% debridement is possible. We try to do everything correctly by following the known protocols, but you never know what is in store for the future with the current solutions we have to solve these problems. Don't feel bad Harold, you are doing your best and you are doing a good job; but none of us are Gods.

I have recently (1-3 years ago) had 3 implants put in. 2 of the 3 are "failing" in that there is considerable bone loss around them and the threads are starting to show greatly. The two in trouble are located in the upper jaw and are a replacement for the two's that most likely never grew in. I had bone taken from my hip before the screws were placed to graft the somewhat thin areas. Everything went well up to that point. Trouble started when I had the temporaries put in. One of them became infected. It was determined that the screw did not fuse all the way around to the bone. I had an emergency rescue procedure/surgery done. The infection was scraped and the area was grafted with donated bone. The rescue procedure worked and about 6-9 months later, I had the permanent implants put in. The bone loss was not noticed nor pointed out to me in Nov '08 when I went for a check up. It was pointed out to me by another dentist where I go for whitening etc. who also specializes in implants. She in turn referred me to a Dr. who tested for infection. At this point I described some of my symptoms. I have described these symptoms before but they were ignored. They include tenderness of the tissues around the implants, bleeding when brushing and flossing and random needle like, sharp or shooting pains in the areas of the implants. I was surprised by what she said in response to that. She said that these symptoms are very typical of something that occurs when different metals are used for the abutment and or the post creating a reaction (an electric discharge?) and causes the bone to deteriorate. Could you please provide more information on the topic or direct me to some source materials where I can research this more in-depth. Time is of an essence to me as I need to act fast to remedy this situation. Thank you kindly for any input.

hmm - I am not sure if I would agree with the theory of diffrent metals contacting causing a series of event s which may lead to bone loss. Get another opinion; a few more opinions.

To Dr. Rudick, Very little appears in the literature about past endo/perio involvement causing endosseous implants to go south. It is an issue and does raise questions. An old OM can have Staph and Strep bacteria lie dormant for up to 20 years or longer. I am not saying don't treat but be aware. Alot of things are out of our control. One can even have bacteria seed from the 5th lumbar vertebra. You brought up a good point. I myself have discussed this issue with fellow implantologist in the past. I remember from my microbiologist days about the 5th lumbar vertebra and mandibular OM's. I recently had a non-implant patient present for dental clearance for orthopedic surgery. This patient as it was hound, had a chronic polymicrobic aerobic and anaerobic infection in his mastoid area. This resulted in two surgeries and a month of iv antibiotics. This man was walking the streets of northern Virginia for years with this lowgrade chronic infection. I am glad that I did not go through with implants.

Dr Hughes - in your response to Dr Rudick's discussion... would you say routinely exo immediate place in such scenarios or graft and wait? I've only been placing for about 5 years. One of my mentors NEVER places an implant in an old perio site while the other swears by never putting the patient through unnecessary additional surgeries. From personal experiences I've seen my own cases that I have grafted and re-entered months later. Although I slept better at night, I wonder sometimes if those cases would have been just as successful in one shot exo / placements provided I got sound initial stability. All too often I open up grafted sites (I've started waiting longer) and I see clean bone, yes, but the grafted material remains loose if enough pressure is placed. This makes me wonder how much good are we really doing with two stage surgeries. Van

Van, I would wait if the following conditions are present: radiolucency of 3 mm. or greater w/ infection, long term perio (full mouth). I would extract, graft and implant if treating a fractured tooth. If using a perticulate synthetic material wait aprox. 6 to 8 months prior to implanting. I woul montlikely not treat an area that had a long term apico with amalgam retrodrade filling or saucerization then graft but no immediate implant. I do not recommend placing an implant into an area of a bone scar from an osteomyelitis. See my comments to Dr. Rudick.

I am following two patients with very late (greater than 5years) rapid (1-2 months) onset peri-implant bone loss. The one change in their history is the use of Prilosec. I wonder if there is any correlation with bone loss and the use of this or similar medications?

Does anybody have experience with treating bone loss down to implant's thread? What kind of success rate is there?

My dentist struck the inferior alveolar nerve when numbing my jaw for capping a tooth. The pain was huge and in a couple days, I could hardly open my mouth. Chewing was nearly impossible and a burning would over-take my bottom jaw. The entire area was numb for 6 weeks. Gradually, the numbness went away, but, one of my 3 implants hurt when chewing on it. The implants were 10 years old and I had never had any problems with them. I went to another dentist for a full xray and there is significant bone loss under the implant. I believe this is very close to the spot the needle went in. The other 2 implants look excellent. Could the trauma have caused significant bone loss? This happened in April of 2011. Thank you, Ken Tinkham

Question please: I have just had all upper teeth removed and am booked in for a consultation next week for implants. Is it possible to use the all on 4 method in this case? or do I have to let gums heal for 3 months. Thank you in advance for answers lisa

Technically speaking from experience one must remove all external avenues of ingress of surgical sites or chronic infection eventual rules. After surgical implants of rods , wires, etc., or cannulas, the site piercing the skin always must be managed with meticulous care or infection and osteomyelitis is the certain result. Therefore after resolution of an injury the apparatus is removed allowing the epidermis to close completely eliminating the possibility of the entrance to infective microbes. In the case of dental implants the problem is the ectoderm cannot close and therefor there is always an open area where the epidermis cannot complete the closure of the wound. If the implant can be manufactured such as to have a surface that is antimicrobial so as to minimize completely the open epidermis or to have an implant completely covered by the epithelial cells so that there is no unhealed wound then better infection free results might be obtained.