CBCT shows problem with implants: what shall I do?

Get your implants removed, bone graft, wait for 8 months & redo implants

Hi, From the looks of the CBCT it does appear that the implants are outside the bony housing. Long term this will likely lead to significant gum recession and loss of the implants. The best approach would be to remove the implants and bone graft the sites to develop an adequate amount of bone to properly support the implants and the soft tissue. Regards, Dr. David E. Azar

"Ray Hardening" often obscures structures near metal or other radio-opaque objects, so thin bone may appear absent. Yours is very thin at best, and as Dr. Azar noted, if it disappears, the implants may fail. Growing buccal bone is difficult, so removing implants and regrafting the very large defect that would result would be very risky in the "aesthetic zone." GBR would be less risky. There are techniques & materials (PRP, Infuse, etc.) that improve your odds. In either case, choose your course of action and surgeon carefully based upon his or her prior results.

First of all I am embarrassed for my profession in what I see. And have great empathy on what you are facing. Those implants were way to large for the amount of bone you had available. I have treated many case such as yours and you have no labial bone over the implants. It appears very likely the implants are on a failure path. And with the inadequate bone that will be available after removal, GBR will not deliver enough bone to place future implants. You will need block grafts to provide adequate width for future placement. I would suggest you find an AAID dentist that has an AF or Diplomate status and appoint for a consult with your CBCT in hand. The CBCT only presents part of the info to fully assess your case. More information is needed to determine the proper treatment route. There is a solution to your problem but you must pursue the experts that are fully trained in how to solve it. Good luck and I sincerely hope you find the right doctor to help you.

Yes "ray hardening" or scatter, can make it difficult to make out certain features, but the "virtual 3D image" clearly shows the threads of the implants, so I believe it is safe to assume that the implants are outside the bony buccal plate. As far as Mr. Stanley's comment regarding "bone grafting" being risky in comparison to GBR (guided bone regeneration) I am not sure what he means. GBR is just one of many techniques used to graft bone. Each of the various techniques work better in some areas and for some clinicians, so which technique might be used on your case will depend on the particular surgeon you choose. I do agree that it should be someone with much experience and training. If Mr Stanley is suggesting to keep the existing implants and try to do GBR on top of them, that has a VERY low probability outcome, and should only be considered after implants have a problem several years later. In this case you have not made the full investment in time and money (the implant restorations have not been completed) AND the implants are still easily removed, therefore is least risky to remove them, graft (with GBR or another technique) wait for bone healing and then replace the implants. I hope this clarifies Regards Dr David E Azar New York, NY

Before you jump into removing the implants, have an expert evaluate their position and explore your options. If they are in the perfect position for the prosthetic reconstruction (the prosthetic platform is at the correct level coronally, and the implant is at the correct angle to place the abutment and the crown) consider a guided tissue regeneration technique with BMP2. A product such as Infuse may allow you to grow bone in the deficient area. You can always remove the implant and bone graft as a last resort. Good luck!

Not only is there a lack of buccal bone but the lingual plate is thin to non existent . The implants should be removed and grafted at the time of removal. If you are missing both buccal and lingual plates of bone and onlay autogenous will be required. This is difficult and unpredictable in the esthetic zone. You may need to consider a fixed porcelain retainer

What about the labial/buccal bone over the natural teeth on the scan?!