Failing Implant #14: Thoughts on Treatment Plans?

If you do opt for removal, you don't necessarily need to use trephines to remove an implant. You can use the reverse torque technique with specialized reverse-threaded screws. See the Implant Removal Kit.

If the implant isn't mobile, by all means have implant repair surgery done. The most predictable method is to remove the crown/abutment and replace with a cover screw so that the implant can be "put to sleep" for 4 months. You can still get good results if the crown isn't removed. But, what caused the breakdown? You have to identify that so that it can be eliminated. The most common cause is subgingival cement, but this one may be a screw retained restoration. The second most common cause is failure to remove plaque, and plaque removal can be compromised by the emergence profile and height of contour and also by simple non-compliance. I would not remove the implant. It is easier to repair/stabilize this implant than to remove it. Do yourself and the patient a favor and repair it.

Keep it, and let the periodontist do his thing ......put it to sleep. Implant in the 13 position would give this patient better function than he has had with 14 in function behind the space. No bruxism, light occlusal force, and cleansability would be a must for 13.

I’ve had great succes removing implants with the neo biotech fixture removal kit. Very conservative and no need to trephine

I'll will go with the removal of the crown and graft after the preparation the implants treats with diode laser or any other instrument that you may have and use the protocol with CITRIC ACID. After this, biomatirial of your election and pericardio membrana fix with the screw tap and also on the buccal with some tap. In my expirience i like to use creos of Nobel Biocare. Success rate on primary clousure will be higher than 80%. Good luck

It's hard to tell how much bone loss there is around the implant, maybe just down to the threads? I think if it's not mobile it's worth a shot to repair it. I would remove the crown, raise a flap to disinfect around any exposed implant surfaces and bone graft. As others mentioned, place a cover screw and let it heal. I would probably lean towards waiting 5-6 months. I'm wondering if traumatic occlusion isn't a factor in the bone loss here. You have a lone molar with no adjacent teeth to support it doing a lot of work for that side. If the pt is a grinder that poor implant is getting beat up. Get another implant in there to share to load.

YOur periodontist gave you the best suggestion.

I agree with you very much. It is not advisable for Tooth #14 to bear such a heavy occlusal load. It looks like you could easily have an implant placed in the area of #13 due to sufficient bone quantity and appropriate distance from the maxillary sinus.

Laser treatment will fix it. No need to remove the crown.

If you really want to do it the right way then do not remove the implant. However, removing the crown and abutment would most likely give you the best access to the implant body and the diseases bone. Once you have removed the abutment then utilize Erbium based Laser technology to reconditiion the surface of the implant. There is not other laser system that can do this effectively. Clean up the bone and decorticate. If you have the equipment then utilize PRF (Platelet Rich Fibrin Matrix)) mixed with bone particulate to graft the area. You could also use Sponge bone ( Dr. Sam Lee- Look him up on You-tube) very effectively here. If you can't get primary closure then use a Collagen Membrane or Pericardium to close. You could probably drop in number 13 at same time and then evaluate the site in 3 months. If the site is good to go then I would wait another 2-3 months to make sure the area is stable from an osteointegration standpoint. The restore.

Request interpretation of the x-rays. I get the impression that this implant is tissue level, but placed bone level/subcrestal. And lower left xray apart, looks like all the big threads are in bone. Or is it bone level fixture, with microthreads occlusally and macro threads apically? And no bone at microthreads, bone at macrothreads?

Even though it is clear that there is bone loss in this conventional radiograph, better to have a CBCT evaluation. If we divide the length of the implant into three 3rds, if the bone loss is not beyond coronal 1/3rd of the implant length & if the implant is immobile regeneration should be thought of as the 1st line of management.

The original dentist now claims he plans to restore with implants in #13 and 14 sites? The first question that comes to mind is why didn't he do that -- place a #13 also -- to begin with? That was very poor treatment planning on is part and it set this implant up for a failure from the start, because it's being asked to bear much more than it's normal share of load. The reasons for its failure can be multiple, as the others have already stated. But the fact that the implant is not mobile and is asymptomatic, AND the greater bone loss on the mesial point to traumatic occlusion and possible bruxing, more than anything else. It may also be indicative of traumatic food impaction caused by the edentulous space in #13 site. You're not there to do the bidding of another dentist who tx-planned this poorly from the start. You're there to look out for the patient's best interests. As such, I am in the camp of your periodontist, i.e.: remove the crown and abutment, clean up and graft, AND place an implant in the #13 site at the same time. Completely bury both implants and don't touch them for 6 months. You'll be glad you did.

I agree completely Matt!!