Failing Calcitek Implants: Options?

It seems to me that you're implant has a severe infection. I once worked for a pioneer in Implant "Sterilization" with Lasers. His name was Dr. Robert Miller in Florida. He is an expert at dealing with these situations I would hope he would comment on this blog. As for what type of dentist you are seeing it does not matter his title but mostly how well versed,skilled and experienced he is at what he does.

This is not uncommon. It sounds like you have a microgap issue. What I mean by this is between your implant and your abutment there is a gap that has formed over time while it has been in function. The titanium alloy is very strong but also very soft. This is not uncommon is the implant industry today. Some doctors will tell you there is no gap eventhough there is a significant amount of eveidence and articles out there to prove this. Some of the implant companies aren't acknowledging this either anymore because they don't have a way to eliminate it. I would get another opinion from another doctor. The problem you will run into is the implant is still intacted and no one will want to take it out. What I have suggested in the past is before things get worse and since they have tried to clense the area in the past and it still didn't work. I would take out the implant, clense the area very well, bone graft the area, wait 3 months, and place another implant...one that will solve the microgap issue. The other options would be to replace the screw retained prothesis (they are the worst for microbial issues) and either get more implants (to eliminate potential load issues) that are cement retained and close the microgap, or get a implant supported denture (using ball tops or locator abutments....which are very stable and function almost like natural teeth now because the of the strength of the implant that is supporting the denture.) Also the specialist who bone grafted around your implant should have known that is is virtually impossible to grow bone around natural teeth let a lone an implant. You can't just pack bone graft material around an implant and expect it to grow back. This is an un-natural procedure. You graft an area that has no teeth or tooth and that is when you can grow bone back, however grafting around an implant is not effective in any way shape or form....especially if there is an infection present!!! Now another question that has to be asked is are you a smoker, big drinker, diabetic? Are the other implants performing well? Or is there bone loss or an inflammatory process around those as well? Good luck in your search and in your future treatments....don't hesistate to ask more questions...now you have to understand that not everyone is exposed to all procedures or has knowledge of all problems that could potentially happen with implants so you can't start pointing the finger...because back in 1996 there wasn't a lot of talk around the microgap issue (if any). However there are ways to correct it now and all you can do as a patient is take a stand and ask your physicans to place what you feel will work the best in your case. My patients hav ea lot of say in their treatment plannings because I give them the knowledge and information to help them choose the best plan I present them with. Now obviously we as physicans need to help point you in the right direction. Again good luck!

First of all, it's not the type of implant that is causing this problem. It is a bone - tissue response to the one implant that is failing. Your body no longer wants that implant there for whatever reason. It appears that implant in the area when tooth Number 9 used to be has failed and is probably beyond repair. There are several techniques to try to restore the tissue and bone in that area, but your previous dentist did try at least one technique. I assume this was a reasonable try. Occassionally, we can clean and treat a failing implant, get rid of all the infection in the area and regraft the tissue and bone in the area. If the infection is gone, there is no micromovement, and the implant is cleaned in such a way as it can accept new bone and tissue, you have a chance that you may save the implant. These failing implants do not generally get better, even with the best treatment. The other three implants are probably in good shape. An ideal solution would be to remove the screw retained bridge from six through twelve, and remove the implant for number 9. A new implant could probably be place in the area of number 8 and the old bridge screwed back into place. After proper healing time, at least 4 months, a new bridge could be made including a screw retained abutment for number 8. When finished, that should solve the problem. You must get rid of the infection and that probably means - take out the implant for number 9. Best of luck.

To JB, I have never seen a microgap cause a severe infection. The most common cause is overlaoad i.e. lateral interferences. The "microgap" if at bone level or apical, will result in 1-3mm bone loss as shown by Branemarks's research. I am assuming that this is a "severe" bone loss (infection) issue as evidenced by pus and the attempt to bone graft. There is no need to bone graft 1-3mm vertical loss due to "microgap." Your comment about not being able to successfully bone graft around teeth is quite ignorant. Please e-mail me back with the scietific literature that supports your theory. Unfortunately with this case I agree that bone grafting around implants is questionable. However, if the occlusal problem can be eliminated and the implant is surrounded by a boney trough i.e. 4 wall defect, there is a good chance of success.

Sir! you have to see a prosthodontist. Since the implant supported "bridge" is screw retained you may have a broken screw that causes that problem. I have to tell you that the Calcitek implants don't have a very good track reccored that's way all the name chages.

Its not the brand, it is a local problem around this particular implant. It seems to have failed and probably needs to be removed. The site can then be augmented to accept a future implant if desired. No one really knows if this infection will affect the heart, but the implant appears hopeless and best be removed.

Its not the screw nor the microgap, its probably a failing implant. Calcitek implants were coated with HA and have had problems with the HA wicking saliva subgingivally/crestally creating the infection you describe. If your surgeon has tried debriding the area, cleansing the implant and grafting the defect, all to no avail, then most likely the implant needs to be removed. I agree with one of the discussors, please get another opinion from a Prosthodontist, someone who is familiar with different implant systems and screw retention. It should be quite easy to remove your bridge, remove the implant and graft the site. If the remaining implants are long enough and well integrated, you may get by with the three remaining implants retaining your bridge. Otherwise, you may need another implant placed and a new bridge made. Please interview and get well trained pratitioners helping you.

From the start we have to make the distinction, between an early or late implant loss (problem). It is essential to make the distinction, because their aetiopathogenesis, and thus also their relationship or mode of interaction with periodontitis. Also compounding factors: smoking, uncontrolled diabetes, genetic predisposition. This patient has the implant placed on 1996. After 11 years he has an infection. Repeated studies demonstrate that bacteria are the causative element for vertical defects around teeth. Occlusal trauma may accelerate the process, but trauma alone is not a determining factor. The implant gingival sulcus in the partially edentulous implant patient exhibits a bacterial flora similar to that of natural teeth. Implants in patient with a history of periodontitis can function successfully for a long period of time, although slightly higher failure rates been reported. In this patient, we do not know how was the oral hygiene, before, during and after the placement of the implant. If the patient was on a SPT programme. When the patient is on regular recall the implant and all the restorative components are checked. Prosthetic connections are crucial to the long term success of an implant. If during the function after 11 years (it could be less) a microgap have been developed between the implant and the abutment, the bacteria is collected in this area and inflammation occurred in the surrounding areas. The elements are susceptible to fracture as well, Thomas G. Wilson,17,1993. Maintenance is very important. Patients with aggressive periodontitis and / or with very rough implants (s value of ≥ 3 µm) seem more sususceptible to peri-implantitis/late implant loss.Marc Quirynen. 2The Institute for Advanced Dental Studies, Swampscott, MA, USA A clinician should, in partially edentulous patients treated by means of implants, be aware of the importance of: 1.The periodontal health of the remaining dentition, which can interfere with osteointegration. 2.The intraoral translocation of periodontopathogens, which can jeopardize the long term success of implants because of the similarity in microflora between periodontitis and peri-implantitis,and 3. The implant surface roughness What I would do in my mouth in a situation like the above? 1. Take x-ray to evaluate how much bone loss and make sure if there is a microgap 2. Clense the area, irrigate it and control the infection with medication 3. If it does not work I will remove the implant curettage the area well. I will wait until the area is clear and then I will have a bonegraft.Wait 3 to 4 months an place new implant. Then, after 6 months place a new implant. It would be easy to remove the screw-retained prostheses. Please, go to a clinician who has experience in the field. I would go to a prosthodontist they are more familiar with biomechanics, or a periodontist. Another question is about if the infection could spread? I would say yes. There are many studies about Periodontal Infections Linked to Heart Disease. We found the mouth can be a major source of chronic or permanent release of toxic bacterial components in the bloodstream during normal oral functions," said Dr. E.H. Rompen Good luck

I would recommend that you ask the dentists that have most recently treated you for a referral to another dentist and/or specialist that they would use if in your situation. Then make an appointment. In the mean time continue with your antibiotics.

I have had the opportunity to evaluate and treat dozens of failing Calcitek implants over the past decade. While there has been alot of conjecture on this blog about the cause of this problem, most of the comments have missed the mark. The problem with these early HA implants is that the crystallinity of the HA was too low. This creates two problems. First, an amorphous surface is more prone to dissolution in the presence of inflammation because the pH of the surrounding tissue goes down. This "softened" HA surface becomes a perfect nidus for bacterial growth. Second, the bone to HA contact is stronger than the HA/titanium bond. After cyclical loading, the HA tends to fracture away from the surface leaving a grand canyon for invagination of epithelium and pathogens. This is why these implants function well for years and then demonstrate spectacular failure over a short period of time. Treatment of this problem is dependent on two things. How many walls in the defect and the vertical height of bone. If the defect is entirely infrabony, treatment of the problem with an ablative laser has a high degree of success. I have previously posted before/afters of implant repair on this website (see photo section), even repairing endopore implants which has the most problematic surface. Without seeing the xrays and the results of a clinical exam, it is impossible to diagnose this case. But debridement with the Er,Cr;YSGG laser (2780 nm) is hands down the most definitive way of surgically debriding the contaminated implant surface prior to regrafting. (Miller, RJ, "Treatment of the Contaminated Implant Surface Using the Er,Cr;YSGG Laser, Implant Dentistry, June 2004). RJM

No Doctor should suggest a specific treatment or jump to conclusions regarding the source of a problem without examining a patient. Everything about cause is just speculationj based on nothing. As was suggested ask your two treating doctors for a referral in your area and get evalulated. Just a note to the above the HA on the Calcitek implants, never my favorite either, was modified in 1992 to do away with the cryslallinity issue. The were also non HA Calcitek impalnts. It is dangerous to suggest solutions without a diagnosis. Find an Doctor and get evaluated. I might mean losing the implant and it might not but doing nothing is not the solution it will only get worse and has the potential to create other problems. Best of Luck!!!!