Failing implants: leave alone or remove?

hi As per patients CC.. and her age ..metal showing through crowns should not be the reason of replacing implants with new implants or whatever ..rpd..no doubt alarming bone loss around implants s evident on x rays If thr s esthetic concern that can be dealt.. If she s asymptomatic ..things are on her side..may be good counselling what that s all needed n that she got from her old dentist.. thanks.

Given the fact that she's 74 yo (if the soft tissue looks ok )and she doesn't want to have any more surgical procedures I would leave as is. You have informed her about the facts. This situation may serve her for some years more.

The patient has spoken. She does not want anymore surgery. You informed her of the facts, and you did your duty. You can stand at ease. You did offer her the ideal treatment. Sometimes patients (people in general) do not want to hear the truth. We see this every day! It may be a blessing in disguise that she went back to her prior doctor.

Not that it's ideal but I have a strong feeling that these are going to last for a while until they actually start having symptoms. Leave them and her alone.

Agreed. If infection or inflammation is absent, leave them alone. I have several similar patients in my practice and as long as they function without pain or health risk (i.e. infection), we maintain.

I agree with previous comments. In fact if there are no concerns with regards to stability of implants we should possibly address the cause for such a significant bone loss and at worst consider some augmentation if appropriate. Removal of implants may be going a bit too far even if this patient were to be young.

Any thoughts as to why they all failed?

Adjust her bite, make her a night guard and put her on 3-4 month re-care. If you reenter and try to re do you are making a big mistake. Just my thoughts.

As aforementioned, if he patient doesn't wish treatment it's their choice at the end of the day, but, I would also inform her of further bone loss and the consequences of there of. We would if it where failing natural dentition which we would advise replacement with an implant, would we not?

I would agree with most of the comments, and respect the patient's wishes about no more surgery. However, it appears as though the implant in #20 site has an active infection around it. Since the implants are splinted #18-21, I would remove the bridge, remove #20 implant, curette out the site and replace the bridge. Verify and adjust occlusion to a mutually protective occlusion removing all lateral excursives from the implant bridge and from the implants on the lower right side. Fabricate a ABP or Full night guard and see how much longer you get. You may even find you get some regeneration of bone around the distal of #21 and the mesial of #19.

The 2 implants on the right side don't have that much bone loss, but it is very important to stop the progression of the gum disease. About the implants on the left side I would remove all the crowns, open a flap and check which implants are moving, or aren't stable; and then remove them, and put bonegraft in the area, membrane, and close the flap, wait 4 months. This patient is only procrastinating and making it worse.

This is very difficult to predict, but i have used the LANAP laser protocol around some implants with bone loss (not as severe) and improved the bone nicely. The tissue responds very favorably. Also, she may have a virus, as Dr. Slots has indicated that 95% of people have Herpes virus. Try Valtrex 500 BID 10 days.

Without diagnosis we should be careful to suggest treatment, because, what are we actually treating? Is this occlusal overload? Maybe, but doubtful. Perio disease? Is there inflammation? Sometimes we see aggressive remodeling as a result of aggressive placement; wide implants and narrow bone. As I wrote above, I have many similar patients without apparent complaint, so we document and measure change over time. It's interesting how many suffered early, aggressive bone loss and then stabilized for a decade. I have many ancient Intergrals, IMZs, SteriOss, etc., wandering in and out of my office with various levels of support.

Let 's back up. Natural teeth have failed. Why? Periodontitis? Implants are failing due to Peri -implantitis. Lower right second molar appears to be failing due to periodontitis and possible occlusal trauma. Before considering more implants, we need to consider patient's history of tooth loss and control disease activity. Where are soft tissue levels? If ther is only limited metal exposure at the coronal aspect of implants, then pocket depths must be quite deep. Deep pockets usually display inflammation /suppuration. With all that we know about systemic implications of chronic inflammation around natural teeth, we really need to look at what we consider as acceptable disease activity around implants.

The majority of these posts say to just "watch" this case. Watch for what? Bone loss to the alveolar nerve? When these implants are finally lost, what will the patient be left with? She will be a dental cripple for sure. We need to plan for the future, cut to the chase, get them out, and move forward while there is still enough bone to support a new prosthesis either implant borne. tooth borne, removable. Recommend this to the patient. If they decide against it, so be it. Document it. You have covered yourself and recommended ideal treatment. After that, it is up to you if you want to take on this maintenance case.

for the case presented, some implants I think are failing ( bone loss more than half implant length ) where the others ( at least radiographically ) are compromised survival. informing the patient about future complications and expected consequences of keeping the situation, then giving alternative treatment options as some colleague described is your job. Patient desire should be considered as well.

Careful Perio check is needed followed by required Advanced Perio therapy. Occlusion corrections as needed. Instructions with proper hygeine care is must. recall visits time to time.

If she has active inflammation I would recommend Lapip. If no inflammation I would leave it alone.

1. we are entering a new dento/medical field: geriatrics and implantology 2. as doctors we are obligated to help--we cannot walk away and watch 3. this patient has troubles-they will worsen--and cannot be ignored 4. as onedoctor suggested reduction of occlusal stress must be addressed--proper equilibraton and night guard will help 5. check patients dietary habits--what does she eat?-does her food contain strong anti-oxidants and stimulators of detoxifying enzymes (broccoli). 6. her physician should be consulted and made aware of problem and her estrogen levels discussed. Estrogen has three basic metabolites and they behave somewhat differently in the body. 7. pathogenic biofilms and their role in tissue destruction around implants need to be addressed.... 8. what about her social life? as we age ,medical/dental problems and social problems become inextricably intertwined and interrelated. 9. is she getting enough calcium? and is the calcium being absorbed properly or is she eating foods containing oxalates that block calcium absorption? 10.until we figure out the cause of the problem we'll not know the possible cure. Bottom line: do not walk away from this problem and live with hope that it will self correct--this problem will not cure itself. There are answers--you will need to try and find them all the while showing patient that you care .Establish some elemental protocol--explain to patient and follow through. Get your assistant and /or hygienist involved (follow up visits/measurments/observations-)-how often? that should be part of your protocol.

Does the fact that....... today, with modern technology we can now offer our dental patients a new set of teeth make us GODS....... it might seem so.... but in actuality, we still have not risen to that level.... we are still merely mortals..... and we have to deal with failures. We, ourselves and our patients must realize that sometimes great dental treatments may end up as failures...this is life... and all the contributors above are correct...... if the patient is comfortable, the present dental situation is not contributing to further health problems or discomfort..... then let the poor lady enjoy the rest of her days with what she has for how ever long the situation will last....... and deal with further problems when they arise.