Implants Placed in Dubai are Failing: How to Identify and Save?

As we receive several cases each month about implant identification, we want to mention that there are two websites online that help identify implants and have large catalogs of implant photos to aid in identification. They are: osseosource.com and whatimplantisthat.com. (Note: In any additional comments added below, please do not repeat the links to these two websites. Thank you.)

Patient’s complaints? There are plenty of X-rays with similar bone atrophy in practice, but clinically they are asymptomatic and patients successfully use them for a long time if it’s stipulated by a good hygiene.

raise a flap to expose the cement and remove it. Untreated could lead to implant failure.

I think that the problem depends on bed fitting between abutment and crown and consequencially overcontact in occlusion caused bone loss Implant used could be alpha bio If there is no mobility open a flap remove implant cement decontaminate by laser bone difect Close flap and Try to remake new crowns with max attention to occlusion and ...hope Probably implant used are alpha bio Best regards

These 2 implants have so many problems that I think that no matter what "heroic" procedures you attempt, loss of these 2 fixtures is inevitable/ if not imminent (along with the natural tooth mesially). If this patient is aged 80+ them maybe we should be continuing this discussion. If, however, she is any younger, then I think the most honest treatment is to remove both fixtures and the mesial natural tooth, and re-treatment plan. Of course, you could always send the patient back to Dubai..

Appears to be Xive implants from Friatech. My preferred means of treatment is open flap debridement with an ablative laser followed by graft/membrane. Looks like a HUGE area of cement left under the prosthesis. Removal of this material and granulation tissue with GBR is highly predictable and should be attempted before anything else more agressive. RJM

I feel flap elevation and bone grafting would help

If the two implants were the only problem I would agree that a GBR procedure is indicated, however, the canine shows bone loss almost to the apex, and I think it should be removed and included in the area for the GBR procedure.

Please post a complete OPG as well & to be honest get rid if these implants & the neighboring root filled canine & heavily restored molar,put bone graft let it heal for 6 months & place 3 new implants! As no Herodontics going to work...Best of luck

Most important is to remove the causative factors. Remove the cement, fabricate a well-fitting provisional and then attempt repair (a la Rosen and Froum in Stu Froum's book on implant Complications or as Bob Miller said, has done, and lectured on in most countries of the globe. I would tell the patient from the beginning that there is a chance of losing 4, 5 and 6.

I do not think they are Xive ( as these are taper shaped and have a taper connection with a platform switch ) anyway , again they have been placed as the surrent "fashion" dictates , that is too deep and have thus drawn the bone level down , especially on the mesial Implant . As th x-ray is low we cannot see the issue with the sinus and whether it was augmented or the implants merely placed with "bi-cortical" fixation . Yes the cement is a big issue as well and the crowns are a long way from fitting correctly or maybe that is merely "double platform switching". Hard to graft this case but could help a small amount . How would I attempt to improve . I would remove the crowns and re-make with two separate crowns and finish to the correct level to help cleaning then monitor. Interesting as well if the RCT on the mesial tooth was post placement due the placement . Peter

: If the cause of bone atrophy had been cement only, the atrophy would have had a local (between implants) placement only

It looks like a Dentsply Xive

look a XiVe X-Ray at http://www.dentsply-friadent.com/bilder/3_XiVE_Roentgenbild.jpg

Stand corrected. Peter

I would remove the prosthesis and abutments, remove the cement, and treat as an ailing implant, just as many have posted(clean up and graft with membrane. I would restore with implant protected occlusion with pier abutments that are easy to clean.

remove the crowns and cement embedded, place the provisional, open the flapp and wash and clean the implant surface, debridin the area , including the root curface of mesial and distal teeth. The result could be the exposition of coronal part of implant and the patient could not accept ti. To prevent you'll need to graft the site. Talk to the patient, there are many things to be taken into account, age of the patient, expences ....

Remove the crowns and abutments of the implants and debride and graft the area and place cover screws. extract adjacent canine and molar and place implants. wait for healing and restore later.

without respect of the implant identification remove the Crowns use a compatible cower screw make a flap ,debride completly with an ER-yag laser (a laser which it's operation is based on cold vaporisation) make block graft .cowered with collagen membrane. [debridment without laser will cause graft failer]

What is the age and Medical Hx of the patient? How is the patients manual dexterity?

Dear Dr. M, The main reason for the bone loss around the implant #15 is the excess cement which is present around it. There is also improper fit of the prosthesis which is aggravating the problem. The canine I believe would not be having any mobility as it has a good bone support present mesially. The alveolar crest height seems to be around the platform level of #14, hence the bone loss would have been present since the time of placement. Thereby, there doesn't seem to be any bone loss around it. I would suggest the removal of the prosthesis followed by the placement of a cover screw and doing a open flap debridement and bone grafting around Implant placed at #15. A new prosthesis should be fabricated after a healing period of 6 months. Both the implants would definitely be a success!!

It would be interesting to see the immediate post insertion X-rays. I find a lot of patients that migrate from one part of the globe to the next, carry with them, all of their X-rays and notes. Why would the restoring doctor splint these fixtures. This patient, would have been better served, with a fixed partial. This case, has the malodor of inexperience! I know we have to learn somewhere, but the balsa model, is a more appropriate place. I agree, that stripping this down to cover screw and grafting is "worth a shot", assuming there is no purrulence, or mobility. Bv

One of the reasons may be the misfit between abutment and prosthesis. Remove the crowns, debride the area and remake them. Please make them with maximum accuracy and fit.