Failing Dental Implants for Denture Stabilization: Any Ideas on How to Proceed?

Remove both implants and start with bone grafting and then new implants.. No chance of saving these.

Reverse torque the non bicon implant if possible, the bicon you may be able to get out with extraction forceps. THese are infected agreed? never augment an infected site wait 6 weeks get s surgical and radiographic stent made off a denture try in and then radiograph (ball bearing in teeth positiosn will allow you to scale teh height of boen avaliable augmentation may not even be necessary it soundslike you need more implants.

Dr. Z: Both implants are hopeless. Trying to decontaminate and graft around the implants is submitting your 70 year old patient to procedures that are certain to fail to provide a benefit for the patient. The previous comments are correct that you should remove the implants, graft, and place more implants. One of the periapical films that you posted shows an adjacent tooth with advanced bone loss. You need to look at the whole mouth and develop a treatment plan that will be prostheticaly sound. Don't get focused on the implants alone. Once you look at the whole picture you may realize that this patient needs more than just these two implants replaced. Good Luck!

Thank you all for your comments. Il definatley be taking the advice

Gotta stop using grafting like it's a must. It is not. Stop recommending grafting base on a radiograph. Remove the implant and let heal. Then reevaluate. And if anything. Implant failure after 5 yrs of function should tell you something about the overdenture. Over loading and provide zero lateral support. Tell the patient to expect similar failure 5 years after new implants are placed. If you graft the site with non-autogenous bone and place new implants at those sites then expect failure to occur even sooner. Put in more implants if you can

Thank you for all the comments ,but additionally : -There might be general perio. problem. -If not, there has been some bone loss, so all the pressure has been placed over the implant, resulting the bone loss around the implant and failure. -Kindly check the occlusion, dental hygiene. If ever you attempt to treat this pt., just advise him to have periodical dental visit. Place the panorex to see the overall condition , pls. -Place more implants if possible. -As everyone said, the implants are lost, and should be removed.if possible place the new implants in new sights, make the procedure as easy as possible, due to the age of the pt. ... GOOD LUCK.

don't be so hard on yourself trying to fix something that can not be fix. Not enough information but for what i can see,remove implants, graft and treat that patient like any other. Mandibulary at least 2 with locators, for the upper the best table is the one with 4 legs but quite often we do a lot more for the patient with 3 implant some time even with 2. Good luck

I would love to know if these were loaded early. Unfortunately the only experience I have with bicon implants is when I have removed failures that looked just like these. I have to agree with the above suggestions , saving these implants is a pipe dream. Do I see a natural tooth next to one of these fixtures? This looks like a case of poor maintenance. I will suggest that failing bicons that are still integrated at the apical aspect are more difficult to remove than others. Ii guess implants aren't designed with that in mind. Remind yourself that you didn't create this scenario, this is no time to try and be a hero! Good luck .bv

Oh, how should you proceed. In my opinion, start pre-op abx. And peridex rinse and a oh visit at the gp's office. Tx plan the pt appropriately and remove the implants( autogenous graft/gtr ) and tx according to new plan.bv

I've had a simialr case- I suggest placing Sendex Mini implants (I think 3M own them now)- it certainly will stabilise the denture and not convenience your patient.

I may just be in a bad mood... Will everyone out there who doesn't know what they are doing stop placing implants. Weekend CE does not make one an implantologist. I continue to be astounded by what I see here. You should ask yourself if this is good for my bank account or good for the patients that we have been charged to take care of and then refer the patient to someone who has a clue how to treatment plan and set cases up for success past 1 to 5 years. I am far from perfect and I have had my share of failures but I try not to violate certain tenants of implantology. I am not saying that this guy is the culprit and I commend him for asking for advice. However, the original doctor who placed the implants is obviously not experienced enough and should refer more often. It just bothers me to see this. The implants must be removed. The general health of the mouth should be addressed first then implants are considered. Additionally, the occlusion should be evaluated and the proper number of implants should be placed to provide the retention sought. Additionally, when looking for stabilization try to place larger implants and if not possible graft to get it.

I would lime to sugest to you to extract both implantes, I agree that they are hopless. Then , because of the patient age, I would extract remain teeth and do dentures fix by Atlas nardos implants by Dentatus. You will have the most confortable results with less trouble for tour patient. Gois luck! Paulo lenci- Brazil

Get the infected implants out fast. Make a set of good fitting dentures built in CR for the patient to wear while healing. After healing evaluate for implants. But first try to determine why the failure occurred. If you can not do this do not do the case, because you will likely also have a similiar result.

Dr c. Can speak for me, in this situation. Who ever suggested placing mini- implants in this scenario can't be serious! This pt probably isn't an implant candidate to start with, but if someone was holding a glock to my head, I would edentulate this guy and give him two wide body implants, after complete resolve of removal/graft. This nebbish, is what gives implant dentistry a bad name ! Bv

Dr Z... a lot of worthwhile suggestions...all are in agreement that the existing implants are hopeless. Good engineering principles will dictate that you must have a sufficient number of implants to make this case work well. The suggestion of Dentatus Mini Implants is well taken, however, for the long term success,( and the patient is in good health and hopefully has another 20-25 years of serious chewing) I suggest from experience, to space the Dentatus implants so that larger diameter root form implants can be buried in between the narrow diameter "temporary minis" and allowed to osseointegrate during their "gestation period of four months" The Dentatus implants will let him function well during the waiting period,and can be incorporated into the final prosthesis should they seem to have integrated. The idea is to allow this patient to have the advantage of implants for the rest of his life. Gerald Rudick dds Montreal

Definitivamente implants failed due to occlusal overload.I see on thexray bone losses vertical light, and checkfor stability or how much support remains for the implants. After that do it bone grafting as regenaform putty and make other implants on the opposite side to distribute the occlusal overload and make new denture. Consider it the age of patients . Thanks

Dr. C, I'm sorry, but please get over yourself. Let me guess, you're some kind of specialist? If not, surely you're an implant snob! First of all, there is nothing magical about placing implants. Every GP should incorporate this service in their practice. Truth be told, if a few simple rules are followed with the placement of the implant, the body does all the real work. Additionally, I don't think it's fair at all to judge the guy who placed these implants. You do not know the circumstances under which they were placed. What if the then 65 year old gentleman could only afford 2 implants and fully accepted the possibility that these implants could fail? Or what if the plan was to place just one in each arch for the short term and for one reason or another the subsequent implants were not placed? I submit that there are WAY too many unknown factors here to be so high horsed and judgemental. Further more, I'd go so far to say that not many people here want to read such unhelpful material. Someone once said "you get good at what you do". How else is one supposed to get proficient at placing implants? Are you so jaded as to think guys are placing implants just to make money? Personally, I think more of our profession and prefer to give the benefit of the doubt to the doctor who placed these. As far as my recommendation, I would say get as much time out of these as possible, if asymptomatic, reline the dentures, and then, based on the patient's financial situation, place 2 standard implants in the mandible and at least 3 in the top. Or 4 mini implants on the lower and 4-6 on the top. Like most things we do, implants take a good amount of planning in deciding how to proceed and the work is mostly front loaded regarding that planning. Informed consent, realistic expectations and honest work are key here.

These implants are obviously beyond saving. However before casting stones and suggesting options one needs all the relevant information.I couldn't comment without full records OPG minimum photos models etc comprehensive exam details including perio and I don't think we should speculate without the info.It is unwise and not proper to do so. Always be careful about taking on others failures unless you really know the facts - it can make for sleepless nights

Hello 1 answer is a big NO to save these implants. Just remove them & plan the treatment according to the condition of whole mouth.

I’m in agreement with Dr Rudick, if the patient wants a implant supported prothesis, consider a case based on full form implants and utilize mini implants to stabilize the prothesis during osseointegration. The mini can be integrated in the final plan or cut off. I have learned first hand that dentures can put great loads on implants. I had one patient shear a 4.3 Nobel Active implant in 1/2! This occured below the internal threads, wow, believe that that guy with F/F dentures is giving them a workout. Good luck.

Kpm, I’m sorry to bust you this way, but to suggest all dentist are ethical is a bit myopic . To suggest keeping these implants, and placing others( ESP. Minis ) shows your lack of tx planning skills , and lack of the most basic principles. In one breath, you suggest finances and in the next you suggest placing more implants in a probable poor candidate. I have to guess your not some kind of specialist, because a well trained surgeon would never consider mini’s for anything other than ortho or temporary retention . Dr. C is probably tired of cleaning up other peoples trash. I on the other hand, enjoy it. Why, because it makes me realize how much better I am than most, and those patients seem to be the most grateful of all. All the while kicking themselves in the ass for letting some greedy, fly by night non trained “doctor” stick it to them. Bv

Dear Dr. Z According to the criterion accepted in the International Congress of Oral Implantologists (ICOI)Pisa Consensus Conference 2007. these ımplants fall in the category of group IV which means absolute failure. So please remove the implants clean the osteotomy sites surgically graft them and wait for the places to heal at least for eight months (BECAUSE OF THE PATİENTS AGE) and reevaluate the places for your treatment plan. Good Luck

Baker vinci, to clarify, I was not suggesting to keep those implants and place others. That would be crazy. Obviously. However, if they are asymptomatic, then I see no reason to take these out and expose the patient to unnecessary trauma and expense. This patient may have come in for a quick consult, just wondering if anything could be done for these “slightly loose dentures”. Or “I get food caught under my dentures but eat fine”. We’ve all had these. Now, as far as not placing minis, I have to guess that you’re practicing some where in 1995? I would suggest that not offering a patient, especially with financial constraints, the WELL proven option of mini implants, demonstrates YOUR lack of treatment planning skills and sure tunnel vision. Graft these areas? Why? These areas are weak to begin with! Use someplace else! Sure, you give the option, but you and I both know that older people are not looking to get into treatment that lasts over a period of years. And, sir, “how much better than I am than most”?…..do I even need to comment on that? You guys are something else. You are the kind of guys (and 20/20 Specials) and give the rest of us a bad name.

A panel of surgeons that place implants routinely will disagree with you all day long , when you suggest mini implants are as good an option as wide body ones. As far as maintaining the mentality of suggesting I’m better than most, I read daily and can tx every complication associated with what I do. I have had 20 plus years to compare my work to others, and will stand by my bold statement. The accreditation process mandates running studies on every surgery I do. I will compare my results with anyone. My 14 years of training and continued ce, and attention to minutiae separates me from others and gives my team and I a lot of confidence. I am competitive in every since, and take great pride in my work. Sorry if this offends you. This is the exact response I expected from you. Bv

This is obviously a case where the surrounding perio condition has resulted in the peri-implant problems. Any further implant considerations should not be undertaken unless that causitive factor is removed. Without an OPG we do not know the number of remaining teeth nor do we know their perio health. Treat that first then look to implants. Those of you who disregard mini implants for your patients do them a disservice. Sendax now 3M ESPE implants were approved by the FDA in 1998 for long term use, and as a practitioner with over 40 years experience in implantology they are the most exciting addition to our range of treatments. Don’t knock them if you have never used them, they are no longer transitional

Kpm, this guy is 71. I played golf with a 72 year old Saturday that shot 68 on the hardest course in baton rouge( 6700 yards ). Speak for yourself when you suggest that this patient wants implants that will barely get him to his last supper. All of us are not sedentary . Don’t graft these big holes in his mandible ? That’s sounds like a poor plan. I would imagine that if we were to edentulate this fellow and place two implants , his restorative doctor would appreciate an even ridge. I represent this facet of dentistry with evidence based medicine. While your placing nails, I’m placing root form implants, as long and as wide as the tx plan dictates. Would you build your Peir abutment home on 3 inch I beams or 12 inch I beams. Did you learn to place your mini implants in a day? Enough of this personal banter. Bv

These are not Bicon implants. They are barrel shaped.

Do you have a recent Pan that we could get a “big” picture?

Kpm, you hang out with chris Hanson ? 20/20 specials follow professionals that act unethically. Are you suggesting such. You support what your 20/ 20 boy Is doing now? Give me a brake!

Baker vinci, let me see here. You wrote back three times, the second after which you said “enough of this personal banter” yet felt the need to come back and attempt to zing me once more, eh? Did I, anywhere, suggest that mini implants were as good as wide body implants? No. Your apparent snobbish prejudice comes screaming through once again. Not to mention ignorance. I don’t care how much CE or years of experience you have. Circumstances dictate treatment, of which we know nothing of here. No one is suggesting that a healthy 70 year old is doomed to non optimal treatment here. Would you please stop coming to conclusions about my motives and treatment modalities when you have nothing to base it upon? On the contrary. My practice philosophy is to offer the best treatment available to my patients while making responsible decisions regarding their finances. Plain and simple. And, yes, I am a GP that does his own surgeries and endodontics and am proud of it. But you don’t see me flaunting my experience and success as you seem to enjoy, sir. Rob Dunn, above, stated what is now known by guys still looking to improve their game and not rest on their laurels…mini implants, while, of course, not appropriate for all circumstances, are not only a bona fide treatment but, in my opinion, we are indeed doing our patient a disservice if we do not give them this option if finances are a concern, especially. Regarding this case, I agree with Leland Judd…I would love to see a PAN of this patient.

Point taken. With all personal issues aside just because something is FDA approved doesnt mean it’s a good product, it simply means it is safe to place in the human body. I have placed mini implants in between root form Implants for temp stabilization on multiple occassions and at three or six months I remove them with a hemostat, most of the time. I have yet to see a true indication where placement of a mini outweighs the placement of a traditional implant. Maybe I should read some gp research. As of now, when finances are an issue I lower the cost. Cease fire!!

Agreed. I will say I 100% agree with you that I have yet to see an indication where a mini outweighs a traditional implant. I, too, will either lower the cost or give a very liberal time schedule for repayment.

I am sure you already have lots of recommendations but here is one more. I am assuming the patient is older. I would take out the failing implants, replace them with new ones. Increase either length or width. Is it the patient’s oral hygiene or systemic disease why they are failing? If it is poor oral hygiene then you definitively need to stress the importance of keeping things clean.

Lol!!! Kudos to Baker Vinci! KPM, you are obviously a GP and that is ok. I am a specialist…OMFS. And I am aggravated beyond words with some in our profession. If you don’t think money is a major factor you are terribly naive. I am so fed up with cleaning up messes that folks are making while they are trying “to get good at doing implants”. Now you have a pissed off,infected, in pain patient who is also ticked about the money they have loss. It gives dentistry a black eye every time and patients spread the word. Oh I just noticed you are a GP. Well good for you if you do everything well. But there is a frickin reason for residencies and specialist. Jack of all trades master of none. Mini implants are a joke! I have rarely seen the long term success that is gained by doing regular root form implants. I have been doing this a long time and have placed hundreds of implants and bone grafts. I know what works and what is just simpleton implantology designed for neophytes. I am not on my high horse I am advocating for proper patient care

As everybody above already said, these implants are clearly failing. I would remove them, debride, graft if necessary, and place at least 2 implants on the mandibular ridge. Remember placing only 1 implant in a totally edentulous ridge is contraindicated because according to prosthetic principles, it can cause the denture to rotate around the 1 implant like a door hinge). The reason to place implants isn’t just retention! If cost is a concerning factor, and you truly want to help this patient to get the best treatment possible, just lower the cost!

One implant not enough sure.If these two are fixed so relief the presuure off these implants with antibiotic in a proper dose plus to add at least two separate implants to hold the denture then you can graft the other two when the pus disappeared and perfom a bone graft. If they are moving remove them and start the work again 4better than three

And don’t even statrDr.C You are sick of cleaning up messes other folks made trying to get good at implants? And you are OMFS? Why don’t you let me know who you are. I will tell all the GPs around your area so that they do not refer any problems to you. This is the problem I have with some of you specialists( Often OMFS ). You complain saying more complex problems should be handled by you, better trained OMFS. And then when you get more work, you say you are sick of it? Get over it. Either deal with it or don’t claim that you can handle more complex cases or cases gone wrong. ANd DON’T tell others here that you were good at placing implants from the getgo. Everyone starts at some where. I see from time to time some of the stupidest works coming from GPs and specialists. So, let’s hang it up and stop being arrogant

I agree with the opinions of many collegues: both the implants Are absolutely hopeless. Remove without waiting the screws and clean very well and let heal 3-4 months almost or more considering patient age. Re-evaluate all with a new panorex, and after decide for a new prosthetic treatment. Also adjacent teeth seems to be hopeless.

Let me be clear... I don't want to offend anyone. I am just advocating for patients. As an OMFS I wasn't good at anything when I started. All I say is this : if you can't deal with the complications of a surgical procedure you should probably refer the case to begin with. Secondly, "first do no harm" don't do things to patients that will cause them to have more problems in the future. We have been charged with the privilege to care of people so let's do our collective best to work with each other to give the best care dentistry can offer. Sorry if I caused any misunderstandings.

Dear Sir or Madame, Cow bone has no indication in a human bone. Cow bone does not resorb and leads to infections and so on... Ask the International Sales Director "Daniel Buser" from Bern because he likes cows so much. He knows nothing about bone biology. Maybe he is an adequate farmer.

Do what??? Bv

The first obvious problem is that there are only one implant in each arch. When have you not seen a patient beat up a unilateral tooth or implant and going further teeth or implants that are multiple but that do not have good spread between them. Bruxism is also a very often overlooked reason for bone loss around few remaining abutment teeth or implants.

While I thought everyone was starting to get along, the last guy is suggesting bruxism causes bone loss . There is little data driven evidence to suggest that statement has any merit .Bruxism in someone with perio dz., will exacerbate the condition, but bruxism is not going to make you loose bone. Parafunction will cause structural damage and breakage of interfaces. Bv

Sure can , as co-axial forces with bacterial presence will lead to bone loss , many cases can lose and small amouint and then nothing for the next 10 or 15 years , possibly due to more " flex" and thus improvced sress managment even though the bacterial status is the same or even worse !...... just another Idea ... from our experience in manufacturing and placing since 1985 . As my friend and colleague says ( he has placed implants 1964 ) , we are still learning. Implants appear to be little bit of many factors when dealing with bone loss issues.

Sorry about some typos there , but fully agree with Baker on minis etc . Was speaking in Switzerland a few weeks ago and sat in a workshop of an eminent periodontal acedemic who repeated that occlusion has no place in bone loss , when it was raised by one attendee it was soon agreed by all practioners ( 30 or so experienced including MFOS )that they thought otherwise. Part of the fun of the job Regards Peter

I strongly differ with the academic.

Yes, part of the fun is agreeing and disagreeing, just enough to question what we are doing on a day to day basis. It certainly keeps us honest. While I have four kids ranging from 9 mos to 14 years, it's difficult for me to get out to more than a couple of meetings a year. I look forward to the continued discussions and will try to keep it professional. Bv

removal of existing implants and placing new ones in different sites could be suggested. two each in upper and lower jaws.

I am sure some of you are concentrated too much to solve the problem without seeing the rest of the oral cavity. I completely agree with Dr. Bob, Dr. KPM and Dr. Leland Judd – to determine why the failure occurred and then suggest a multiple choice treatment plan.

Dr. Alex, with all due respect , how much do you have to see? The patient is missing almost all of his teeth and has two failing implants . To do anything other than the absolute simplest, time tested tx, is I'll advised. Every recommendation I make is with the cause of failure in mind. Bv

Well said, dr. Vinci. This is not the first time you are one of the (few) voices of reason!

These look like Bicon implants to me. The varying angles give differing radiographic appearances. I may have missed it, but in my experience, it is common to have a person come in and choose a "retention only" implant treatment plan, i.e., one in which the implants are not to support the occlusal load, but only to hold the denture/partial in place. Regardless of the implant brand, these cases can easily become overloaded as the ridge resorbs if the patient does not come in for routine exams and relines. I am currently doing everything in my power to get one of my patients back in for a reline since she had chosen a "retention only" implant treatment. Her mother says the patient is enjoying the implants taking the chewing load and that she is biting off tough, chewy and hard foods routinely! So, a few years from now, this patient could come back with a similar appearance, and I would not like to be raked over the coals as having been responsible. John