Failing Dental Implants: Anything I Can Do to Rescue These?

your best would be to flap buccal and lingual, remove all granulation tissue and decontaminate the implants. i would try to use an implant (non metal) curette and an ndyag laser on the surfaces. would also irrigate with gentamycin opthalmic. then graft with your material of choice hydrated with more gentamycin. place a long term resorbable membrane, and cross your fingers and wait.

It appears that the bridge margins and the abutment margins do not meet. In other words the bridge does not fit very well. Another option you may want to consider is to remove the bridge, debride and detoxify the bone defect and the surface of the implant with any of several lasers on the market, graft with beta tricalcium phosphate and cover with titanium reinforced membrane. Release the periosteum for a passive flap closure and place prf membrane under flap. You are resubmerging the implants during this healing phase. Make an Essix temporary for comfort and to avoid pressure on the grafted area and wait 4 to 6 months to uncover and restore again. One of the implants looks possible, the other is very questionable. Good luck!

I dont believe you can save the implant at 26 and 27 has significant bone loss on the mesial and may be lost too and needs to be eval when implant 26 is explanted. 23 may be amendable to grafting but would suggest remove prosthesis, place healing screw and graft after detox the exposed threads on 23 and after implant 26 removed graft place long term resorbable membrane and close allow to heal 8 weeks then place implant at 26 (if 27 is removed then place one at 27 and also 25 allow to heal 3 months and restore with new bridge

Hey guys it must be "implant failure week". Dentistry is a tough and I hate doing "Heroric" dentistry. As always my first question: Why did it fail?. Address it and you solve your problem. My suggestion: remove the implant that is failing, bone graft the site and then place 2 fixtures in good (parallel) position and away from the canines and then restore the case. Gingival graft as needed.Good luck.

First of all dr,you have to check the area clinically that how much walls of bone are present over there.If three walls are present clinically then you have to do through removal of granulation tissue then bone grafting and have to lase the implant surface and it will be better if you can remove the prosthesis for the short time.

I hate getting these types of cases as new patients. Mainly because when I start messing with something that was done somewhere else it becomes my problem. The patient wants a full denture, I suggested otherwise. Thanks for all of the comments. God Bless you all.

I'm not gonna make a suggestion on how to fix this mess , frankly because my battery would die before I got done. I will comment on the obvious, however. Why did this guy place these implants in the first place? Not only are these obviously difficult to clean, their failure has subsequently left the adjacent teeth severely compromised. In my opinion, if implants are gonna be placed here the end product has to be better than the alternative. We place implants to avoid splinting teeth together, to optimize the pt's ability to clean and to preserve bone. None of these principles have been met. Do no harm right? Unfortunately, someone has left a smoking bag at your front door. I would give the guy thAt placed these first dibs at fixing it, and explaining it. Bv

Punt!!!! Get these implants out, graft then reassess in 4 months. Place implants if possible ideally. Warning you won't be able to graft against the canine and it looks as though that tooth may have to be sacrificed due to bone loss. The implants have not been placed along the long axis of the occlusal forces and the parallelism is suspect. All of which contribute to implant failure.

whats the chiefe complain???? how long ago were these placed back...if more than 5yrs than frankly they are not going to move for another 3 years... Thats what they look like... Come on...its incisor area...we place a 9mm in maxillary posterior area(150 lbs & more )of preussure area.. They still have a life...unless u wana jump in like a butcher... Treat the patient... Not the radiograph bro!!! Secondly any grafting etc excercise wud just just be very bookish...rehabilitating the anchorage lost would not be possible by superficial painting wid the htr etc..its not going to be the rehab functionally/fabricationally... It wud be rather a white wash on a old building.. So u mite take em out n place again!!! B.o.l

on second look...how about involving the canines...now that the fire has reached the city....out of the jungle!!! Itend to agree wid dr. Mc

I am very interested in hearing from those who have posted above that the failing implant should be removed (which I tend to agree with) just how you would accomplish this without causing irreparable damage to the adjacent canine. Thank you. Steven

Hello Dr. C, Someone said, 'Treat the patient, not the radiograph', and I agree whoeheartedly. If the patient has no symptoms, then don't go in with all guns ablaze on your motto of 'See defect, will graft'! Although you may be theoretically correct, the patient will perceive you trigger-happy. This defect is obviously due to patient's inability to clean under the bridge (or maybe was present from day one, who knows?) Classic peri-implantitis with moderate bone loss, early on another. I can actually see a piece of calculus deposit on the bad one, although a 3d-scan is urged for better planning. If patient is in good health, then, remove prostheses, assuming these are screw-retained, and SMELL the cotton pellet packed by previous restoring dentist. If you smell the nasty anerobic smell that I can assure you will be there, which comes from a rotting cotton plug, then this is the focus of infection, coupled with Branemark's loose fit design in the older systems. Just place a GP plug on screw head, then composite. Leave no space for bacteria to thrive. Having said that, there is a need for debridement of implant surface and possibly a graft with membrane. Also, get your lab to turn pontics into bullet/cone type with a smooth double-glaze, and things will improve within no time. I don't believe drilling out this implant, then regrafting then reimplanting is something both of you will enjoy very much, IMO. Good Luck!

Interesting to see someone else use their nose. I can smell bacteroides from a mile away . Do patients give you the same perplexed look when you "waft" the area? Bv

Steve, while trephines work well, this is not a case that I would encourage its use. I have had good success with using a small bur on an impaction handpeice, removing bone just from the anterior 180 degrees of the implant. The fixture will come out without doing anymore harm to the 27 tooth. Small round! . I unfortunately have had a lot of experience with this. Bv

I'm interested that Drs Shukla and Baker still use a cotton pellet to plug the screw hole on their implant abutments. However bug-tight the subsequent overlying restoration appears to be the cotton wool will always become contaminated and there is always a disgusting smell when the crown is removed. Most UK implantologists use plumbers tape to plug the screw hole. You can buy a 3 metre roll for £1 ($1.50) from any hardware store. Enough to last your career and no nasty pong!

John , I'm not sure what you mean by that. I haven't seen a cotton pellet since I was in dental school 22 years ago. We do have 2x2,and4x4 gause and lap pads. That went over my head,sorry bout that. When I say I can smell bacteroides,I mean I can smell it down the hall. Should I get some cotton pellets? I got on the sight to learn! Good day, bv

Maybe the word, waft, threw you off??? Bv

Dear Doctor, you are entering into the fabolous world of "real implantology". I would think first in the ANTERIOR MANDIBLE, more than the implants. It seems that tha canine has a periodontal disease, I'm sure it has movement, so what are you going to do with this canine that is affecting the implant? If you decide to extract the canine you can't place an implant because the axis of the other implant is in the way of the canine. So first, if the canine is completely healthy and you decide to keep it in place. Remove the prosthesis so you can valuate if both implants have no movement. If both have no movement do a flap surgery remove all the granulated tissue and detoxify with "Metronidazole" you can read more about this searching Dr. Alain Simonpieri, do a bone graft with particulated bone, first doing perforations to the cortical, you are going to use a lot a lot of graft maybe 1.5 cc and you can place a collagen membrane retained with the second fase healing screws. Or you can load again the implants with the bridge, because they have no movement. Now if the implant with worst bone loss has movement, remove it, extract the canine and place an implant in the caince socket, maybe 13 mm long, then do a bone graft again detoxify and place again a lot of bone graft with collagen membrane fixed with the healing screws. Maybe in four months you place two more implants in the middle. Good luck.