Failing or Ailing Implant?
This patient had an implant placed in #10 site. About a month or so after the implant was placed, infection set in and caused some bone loss. You can see the bone loss and deep pocketing around the implant in the radiograph. No bone graft was performed by the surgeon (Was that a mistake?)
I am trying to determine if this implant is failing or ailing? Long term, the concern is bacteria getting caught up in the pockets around the implant and leading to infections and long term success may be compromised. What do you think? What do you recommend that I do at this point?
24 Comments on Failing or Ailing Implant?
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Paolo Rossetti
7/3/2017
This implant is going to have serious problems sooner or later. Since the healing screw is still in place, I would remove it, let it heal and start over again.
aungken
7/3/2017
Paolo,
Thanks for the recommendation. I have had one surgeon say exactly the same thing.
OMFS
7/3/2017
In view of the fact it is an esthetically important area and only 1 month post-op, I would remove the implant, allow for healing, and reconsider treatment at a later date. Personally, I would recommend an Astra implant because of their demonstrated decreased loss of bone in long-term follow up. This is a very difficult location to place implants and depends on quality of bone. Possibly a maryland or conventional bridge could be used.
S Low
7/3/2017
If this implant has no mobility, flap it and determine the degree of osseous resorption. Then make a decision to do implant repair and or extract.
paolo rossetti
7/3/2017
i would not repair anything. flap elevation would compromise the vascularity of the site and possibly would induce an additional soft/hard tissue resorbtion. not to metion the papillas... just unscrew it.
greg steiner
7/3/2017
Hello OMFS
As my interest is bone and I have little interest in implantdesign I am not up on current research on the long term results of different implants. I use Astra implant and they perform beautifully for me but if you have access to a reference that compares long term results of different implants it would be appreciated if you could post this reference. Thank you.
CRS
7/3/2017
Hi Greg Quick question Do you have any experience with removing a spline type Astra abutment? There does not seem to be retreivability. I would like to send you the case photo and xrays. Please advise.
Gregori Kurtzman, DDS, MA
7/3/2017
Different Greg but will comment grin
if your having trouble removing a healing abutment or restorative abutment from a spline implant (thats a Zimmer not Astra) its possible that the splines got distorted and the abutment wont lift off. That can typically be seen ona radiograph as a gap is noted at the bottom of the splines or you can feel that clinically. Unfortunately if the splines are damaged the implant can not be restored and needs to be explanted as no way to bypass the splines.
greg steiner
7/3/2017
CRS
Thank you for your question but when it comes to anything metal I just act dumb and have the general dentist deal with it. To confirm my ignorance in this regard I don't even know what a spline type abutment is.
Gregori Kurtzman, DDS, MA
7/3/2017
http://www.zimmerdental.fr/generate-image/5225adcceea7221258000005/1/x/x/crop/Spline.jpg
aungken
7/3/2017
Actually OMFS,
It has been over a year since the initial implant surgery. After the surgery, maybe 2 months after the surgery, infection set in and antibiotics were prescribed to halt the activity. Unfortunately, bone loss occurred and now it is as such. Also, would you have recommended a bone graft in that area? # 10
aungken
7/3/2017
The implant has no mobility and is well integrated into the bone. I will investigate flapping it.
Gregori Kurtzman, DDS, MA
7/3/2017
I would agree with my fellow practitioners. Remove the implant and graft the site to try and get the bone level to the CEJ of the adjacent teeth. Allow it to heal 8 weeks then if the graft looks good on the radiograph place a new implant at the proper depth doing additional grafting if needed. Cases in the esthetic zone shouldnt be rushed if you want an esthetic result.
Oleg Amayev
7/3/2017
What kind of implant is this MIS?
paolo rossetti
7/3/2017
it looks like Legacy from implant direct
CRS
7/3/2017
Was this implant placed deep? Seems like dieback to first thread?
Jim
7/3/2017
The elephant in the room, regarding removing or grafting, is the buccal position of the implant and where the buccal and lingual bone levels are. I would also like to know if this was an immediate extraction/placement or 2 stage.
aungken
7/3/2017
Great question, this was actually a two stage implant. An extraction was initially done on the tooth and allowed to have the site healed for 6 months. Then the implant operation was done. Initially, the implant was fine and level. However, after an infection set in, the bone around the implant dissolved. As you can see pockets abound, just waiting for bacterial colonies to increase.
Ed Dergosits
7/3/2017
Why was the implant placed 6 months after the extraction? This gave the ridge time to resorb. Using an implant with a platform switch is always a better choice.
Kevin Frawley
7/3/2017
It would be important to see the immediate post op xray to know how much bone has been lost. Also what does the tissue look like now? Does it match the adjacent teeth esthetically? Is there any inflammation? Also how many months post op are you now? You said the infection happened at one month....
I think all these factors need to be considered before deciding what to do.
aungken
7/3/2017
Kevin, thanks for the insightful questions. I shall find the post op X-rays to see how much bone was lost. At the moment the site is tender and sensitive 1 year after the initial implant. It is not bleeding by any means, but the when probed, there is a noticeable reaction.
Gregori Kurtzman, DDS, MA
7/3/2017
Ok will change my recommendation as i thought the original post implied its been in a month. At this point I would flap it place a flat healing screw, use a laser if available to clean any exposed threads, treat the exposed threads with citric acid gel rinse cover the entire implant and cover screw with a putty graft material (APRF better if available) place a long term collagen membrane get primary closure. Allow to heal for 3-4 months then uncover. can temp it during this by bonding a piece of ribbond across the lingual and build pontic out of composite.
aungken
7/7/2017
Dr. Kurtzman,
Thank you for the great advice. I think these are great recommendations to at least prolong the possible life of the implant. I did want to try and have grafting material put in there to get it back to the pre-infection state where there was more bone around the implant. Also implant was # 7 not 10. My mistake.
I am also uploading the pre-infection photos to so can actually see how it was before some of the bone was destroyed. These are post implant photos, right after original surgery.
Gregori Kurtzman, DDS, MA
7/7/2017
You have a little bone loss and upon flapping may see more threads on buccal exposed but would still follow the decontam steps I suggested. Key IMHO is getting primary closure over entire cover screw which means a wide flap that is mobilized to lay tension free over the crest.
Is the patient a smoker? that may have contributed or whatever provisional present was bouncing on the healing abutment placed at implant placement.
