Normal Bone Loss around a Traditional Flat-Flat Implant Connection

"If it ain't broke, don't try to fix it"...….this situation is not ideal, but certainly manageable. The patient should be encouraged to practice good oral hygiene, use dental floss and interproximal brushes, and keep it clean...…. it may last forever without causing any problems. Changing the crown is not going to restore the bone loss.

Best to leave it. Patients really can't clean biofilm from implant surface anyway. Tell the patient to use a Waterpik with the Pik Pocket tip just under the tissue to help blow out food debri and let it be.

All comments are reasonable, but if it were me I would explain what is going on and if the patient is happy to proceed, I would remove the crown, re-contour the emergence profile and re-position the crown and make sure the patient is able to clean. The Waterpik suggestion is a good one – we routinely recommend this to implant patients.

This type of implant has two alternative collar configurations available, one with a 1.5mm machined collar and the other with 0.75mm machined collar. There is no description about which one was used in this case. Nobody worries too much about slippage of the bone support down a machined surface, but there is concern about loss of bone support down on to a rough surface of the implant, particularly if this is also threaded. The reason for this is simple enough, the surface is virtually impossible to clean and peri-implantitis can cause progressive loss of bone support. Platform switching and conical connections are separate discussions, neither of which necessarily confer greater safety from bone loss and peri-implantitis. In this case it would help if there were pre-operative and immediate post-placement radiographs available for us to compare to the current situation. It would also be useful to know if this is an implant with the wider machined collar. It is not possible to say with a single radiograph if the bone support is stable or declining.

I have had profoundly positive experience with recommending a WaterPik with hot water and bicarb of soda both for perio of natural teeth and implants. Additionally it is logical and a good analogy would be cleaning your concrete with a Karcher high pressure gun! Oh, plus no bleeding after a few weeks of diligent application.

The perception of many is that bone is some material one can put a screw in without some consequences. This is especially true when an implant is placed in an area where bone was grafted. We place implants immediately, 4 or 6 months later and assume that we placed it into a substance that does not respond. Bone that replaced the graft material does not achieve the density of native bone in such short time and perhaps it would take years to achieve comparable results if ever. In my experience, bone always resorbs to some degree after placement of an implant and that is why the idea of platform switching came into existence . The connection of implant to bone is void of ligament and I am sure that that has something to do with the direct application of pressure to the bone adjacent to the implants. Bone undergoes changes systematically without implants.

I agree with the majority of the other comments. But I would explain to the patient (or referring dentist) showing them the X-ray and pointing out that even their natural tooth #15 has bone lose., on all sides of the tooth. Hygiene is key factor.! If patient is catching food around crown then change it. If he is not then I would not recommend changing it. As my father would say "keep it simple". He was a dentist also. In restorations like this the lab is key, we have to have good communication with our lab. Explaining exactly what we need in our restorations. My humble opinion. Good luck.

Radiographically this 2 dimensional picture only tells part of the story. There is no Periimplantitis. I am assuming there is mucositis. Mucositis has a different histological appearance from gingivitis. Anatomically the connective tissue fibres around the implant-crown interface are different from those around a natural tooth crown-root interface. Longitudinal vs. horizontal connective tissue fibres. This accounts for a poorer protection of the spread of plasma cells that fight the bacterial onslaught. Not all mucositis progresses on to Periimplantitis, but all Periimplantitis starts off from mucositis. In short, it would be my guess, from my experience, that the emergence profile of the crown on the implant shown is over-contoured. I would extrapolate therefore, that there is likely mucositis around the crown-implant interface area. In the ideal world the best long term results would be gained by ensuring a post with chamfer, a crown under-contoured subgingivally, with a good emergence profile and good embrasures. The patient should have 3 monthly maintenance around the implant regardless of the presence or absence of Periodontitis. This is a detailed explanation, based on an assumption from a radiograph, of how I view this case that does not seem to have Periimplantitis.

I think a lot of people missed the point of this post. The implant is stable, the referring dentist which is the patient’s daughter mistakenly thought there was excessive bone loss based on this radiograph. The point is that bone loss to the first thread is normal and some people mistake it as a problem. I suggested possibly removing the crown/abutment for better contour if she desires.

I think the reasons for bone resorption are a the very big crown poor mesial and distal contacts and small diameter of the implant. Please take of the crown maintain the hygine around the abutment make a new and a smaller one with new contours if possible try to divide the occusal lode using adjacent teeth.Good Luck.

There is a big gap between second premolar and second molar teeth, you can not insert larger implant than the one already inserted, because of the labial-palatinal thickness: so I prefer to insert two implants 'instead of one. This way, there won’t be any food and bacteria accumulation because of lack of biological counter of the crown. This is why, there is a bone resorption around the implant.