Bone resorption and possible abscess: what to do?

First of All thank you very much for your kind reply ... As I mentioned previously I'm a resident in General Surgery Department (Medicine) with no experience in dentistry , I moved to work in Germany ... and was operated before traveling in my Homeland and then I took the Xrays with me to Germany , at the moment I'm in a vacation in my Homeland and unfortunately I forgot the preop. films there in Germany ... but I can upload it in 3 weeks ... As I remember the Implants were almost at the level of bone crest level , and as I remember there was no bone loss before the treatment ... Flap healing took 2 months because of adaptation Failure (left side) , it was like a secondary intention healing , but the implant was never exposed , there was always granulation tissue above the surface of the Implant (left side). I was in my doctor clinic again before few days and he told me that he assumed that the cause of bone loss is the delay in proceeding ... he said that the abutments should implanted on the 3rd or maximum 4th post op months , and as waited for 7 months , I got the bone resorption ... He told me that the implants are long and stable ... and he thinks that we don't need to do anything , and we have to proceed normally ... He told me also that I have to do xray check in 6 months and when bone loss is progressive then he will do the bone graft ... he said that he can do bone graft through a lateral small incision and he will not have to take the abutment and the crown out !!! I don't know if this scientifically possible or not !!! At the moment the gingiva looks pink and healthy with no pain or redness ... he gave me an appointment for Caps Healing implantation in 2 days ...

That's just not true, there is bone loss not due to delay in proceeding. I would fix it prior to loading it would be easier. Poor advice. At this point I am not going to comment further just reread my posts.

You know these are some interesting points, caries on impacted wisdom teeth with distal pathology #17, recurrent decay and a few open margins. I was taught in dental school it is the dentists responsibility to proceed with caries control first and/ or periodontal treatment if needed. I don't know how the decision to place the implants were made but I feel it is squarely in the control of the treating dentist to determine the treatment plan. I see this a lot in my speciality practice so I can't judge how the decision was made with the "implant goggles" on. All I can go on are the points mentioned above and two deeply placed implants with early bone loss and quite a surgical story. Unfortunately I have seen the rush to place implants by inexperienced dentists then defense of the complications and /or unexpected outcome. I find that if implants are placed in sites well prepared, at the crestal level with a good emergence profile and good follow up and oral hygiene success is more likely. The implants are well below the CEJs of the adjacent teeth which is usually not preferable in the molar areas. I don't think it is fair to assume that this patient only wanted implant replacement since the treating dentist should have control of the treatment protocol even if the patient insists on a particular treatment. Just MY opinion Thanks for reading.

Thanks a lot for commenting and your interest to help me ... I'm a resident in a general surgery department (medicine) not dentistry and I don't have experience in dentistry ... so I apologize if I described something wrong or not precisely ... Flap healing took 2 months because the wound was not properly closed (thread was too loose or not good knotted) , I was operated in my homeland and after 3 days I had to travel to Germany were I work , therefore I couldn't do check up with my doctor ... I noticed that the wound is open (left side) but there was always granulation tissue above the implant (the implant were never exposed) ... I was also with a dentist in Germany but she advised me to let the wound for secondary intention healing as I had no inflammation ... Regarding the other problems , my Dentist told me that I have caries in Molar #18 and I was treated , otherwise he didn't told me anything !!! so if you please tell me where the other problems are , so I can treat it ... Thank you very very much for your Help ...

My Dentist told me that he prefers not to do bone graft directly , he said that the implants are long enough and stable and I should do xray again in 6 months , when the bone resorption is progressive then he will do bone graft through small lateral incision !!! Is it possible to do bone grafting through lateral incision without taking the abutments and the crowns out ??? Thanks a lot for replying ...

I agree with the treatment sequencing, but we were not there during the treatment planning discussion. I think one has to be careful when jumping to the quick fix in extra wide implants fixing everything. There has to be adequate live bone supporting the implant to maintain it if all the surrounding bone is removed to support an inert implant it will fail. Also the multiple problems cited are related to several factors, occlusion, depth of placement, emergence profile and restoration. The timing on when these things happen aids in the diagnosis. For example pressure necrosis at placement usually rears it's ugly head very early on within the first few weeks, these implants are appropriate size but I feel were placed too deep or that the crest was not grafted at surgery. I was not there but can only speculate. There seems to be a consensus on placing implants deep, and using wider implants to prevent problems with restoration and fracture but this is not accurate. One needs to understand the surgical parameters, occlusion and biology vs just placing a wider implant which is looking at it from a technicians or mechanical viewpoint. And by the way based on this panorex only this case should have been a slam dunk in experienced hands, but I understand that healing cannot be controlled.

CRS I think that now, after you visited my website and saw results of Russian AAA technique in combination with 7+mm implants , you might be not so confident, opposing wide diameter implants :).

I can't make any evaluation on a triple A technique since no one seems to know what it is and it appears you may have a sales agenda and are using this blog to promote some technique that you invented and plan to market a course on. I can tell you that my advice is confidently given based on education, experience, and humility. And by the way my credentials are superior to yours but I have the grace not to compete with you.Your website does not post any three dimensional films to evaluate the buccal plate, nor how these implants fare with time. I would advise not posting other's failures I feel it is unethical advertising. Perhaps you may consider more conventional avenues such as submitting your technique to a peer reviewed journal vs leading everyone on this blog as a dentist looking for a solution to a clinical case vs someone with a promotional agenda with a case already treated and asking questions that you already have answers to. No one enjoys being mislead.

Cant tell where the bone really is as its a 2D image and although you can see even in the mesial the level of the palatal bone, you cant tell where the buccal bone is and on the distal there may be bone loss but its overshadowed by the palatal bone.

Thank you very much for commenting ... I do wash my teeth 2 - 3 times daily , also with teeth floss . I visit my dentist every 6 months and in the last year I did multiple Panorama and Periapical xrays , but no one except for the last time has mentioned that I have carious problems .... I was also with another dentist and he told me that I have caries problem in Molar number 18 and he treated it ... Would you please tell me where are the other caries problems so I can treat them ? And o fcourse I will upload the post treatment panorama and photos ... Thanks again ...