Pain in Implant from 8 Years ago: thoughts?

The implant has failed, it should be removed and grafted. Sorry 212-581-4646 we can help !

There is substantial bone loss. Provisionally, an antibiotic (Arestin) can be placed in the implant sulcus until it can be removed and grafted. Consider a conventional fixed partial denture to replace this.

The BONE has shrunk and fails to hold the implant due to ongoing infection. Implant should be removed as soon as possible, and the bone left to heal for a minimum of 6 weeks before any new intervention. Very unprofessional of that dentist not returning your calls, unless there is a legal issue present.

The implant has FAILED ! All the bone around the implant is loss. It has to be removed. A bone graft is necessary and after 6 month a evaluation of bone and graft. It looks like ther is enoug bone to make another long implant after 6-8 month.

The implant has failed. The adjacent teeth have crowns therefore I agree with a previous post. Have the Implant remove and the site grafted and then have a fixed bridge placed after the area has healed, which would be months later. I am surprised that the Dentist you saw did not explain this to you.

Again the implant has failed and given the back tooth has a root canal I would recommend having bone regeneration and a new implant.

The Dentist did not return your calls possibly because they are expecting a malpractice action. Very unprofessional and maybe actionable by the State Board of Dentistry or whoever licenses Dentists in your state. If they had you sign proper consent forms a malpractice action would not be successful but the malpractice insurer might settle rather than bare the cost of a successful defense.

I believe it is one thing to say that the implant "appears" to have failed but to start a treatment plan without seeing patient clinically, let alone condemning other practitioners without knowing the other side of the story is dangerous and possibly unethical!!!

Why are we accepting questions from patients.? And how do you know whether this is actually a patient or an attorney looking for a cause. Do you know anything about this case? Do you have the immediate post-op radiographs or records? Do you know whether the patient had returned for follow-up care or normal maintenance from 2010 to 2018? Did this patient see other dentists during this time or just 8 years later when there was an indication of a problem? These lesions do not appear overnight and ANY suggestions of cause and effect without due diligence is in itself legal malpractice. RJM

Sadly, the implant has failed. Why is an important question and should be determined. X-rays taken at the time of placement may be helpful. I'm willing to consult on this if you'd like. I am in NYC, Manhattan.

Totally agree with Craig Wright. The implant definitely needs to be evaluated and most likely has failed. Definite treatment plan should be recommended by a dentist that you see. Failed implants do happen for various reasons, and not necessarily because the clinician who placed the implant did anything wrong. Each case should be evaluated individually.

It’s been 8 years. Curiuous why you guys suggesting legal action?

Thank you very much for all your responses. They are all very helpful and confirmed my suspicion that implant was probably failing for some reason. I have finally been able to schedule an appointment later this week with the dentist who placed the implant, and will speak with him about removal and the recommendations. Worst case, I will be looking for a new dentist who will remove it and graft, as suggested. By the way, the issue for me was that I was originally referred to the specialist who placed the implants, by another dentist who I no longer go to. So my current dentist had to first get in touch with the referring dentist who was then supposed to contact the original specialist. It has been a tortuous process. I should mention that I am very conscious about my oral health and see a dentist annually or sometimes more, and follow all advice.

To Robert Miller - great question. This is to me a collegiate clinical forum to address any implant concerns. It should remain as such. I understand the importance in patients trying to understand their own condition, but in my view a patients forum should be in that Dr’s office. Thank you for all your professional advice. In addition I would like to note that any attorney attempting to bounce off a case on this site should not be able to use any findings that could bring a colleague here into his or her case. Just my thoughts.

Before listening to anyone ( including anyone on this discussion board ) you should seek an opinion from a local oral surgeon ( not the dentist who placed the implant ), Good Luck.

Perhaps we should all slow down a bit here. Let’s not do any definitive treatment planning without a real patient in OUR chair. And , certainly, let’s not condemn the previous practitioners because anyone who has placed these for 20 or 30 years plus knows that failures occur for multiple reasons. It “looks” as if the implant has indeed failed. And if it has, it needs to be removed and a possible graft placed to restore the missing bone. There are 2 favorable options for restoration: fixed bridge or new implant. This is something that the treating dentist and patient need to work out after looking at all the positives and negatives. One thing that would tip me toward a bridge is that the adjacent molar has had endo AND the mesial margin looks suspicious. If there is leakage, and only a chairside exam can tell, then when replacing that crown , it would be simple and economical to do a fixed bridge. If everything else is fine then the implant is also viable but probably more expensive and time consuming. Go see a good restorative dentist who also provides implants. Get their opinion and if you need another opinion seek it also. This is not a tragedy , only a temporary setback. Yes, we should entertain questions from patients. We should not be a secret closed society. We should offer opinions when asked but guard ourselves by remembering that things many times look different in person than on a digital presentation. Above all, we should NOT use this forum to recruit new patients.

I concur with the response from Robert Miller entirely. Unfortunately we live in a very litigious society where medical/dental treatments are subject to the same or sometimes higher levels of standards as opposed to some other professions. Having said that I think it would be critical to have the patient see the dentist (either the same one who placed or a current one or a new dentist) to have the implant evaluated. Implants are foreign bodies and can fail due to a variety of reasons. Without access to the previous records as well as follow up notes for this procedure it is not prudent to comment on the possibilities of why it failed or the future course of action. We have incomplete information presented here (e.g., do we know what the opposing dentition/forces are being transmitted to this implant structure). Do we know the quality of bone in this area (previously and at this time)? Do we know the quantity of bone available in this area (previously and at this time)? Do we know the reason for the missing tooth in the first place (was there an infected site prior to the placement or was the original tooth fractured or was the site a fresh extraction site or was the site a healed site prior to implant placement). Do we know the occlusion for this patient (i.e., is she a bruxer or clencher, does she have a complete or an incomplete dentition, etc). In considering these previous few factors and more that are not listed here it will be best for the patient to go in for a consult with the understanding that implants can and do fail for a variety of reasons. However there are always alternate treatment solutions or repeat treatments that can be performed successfully. In all honesty this type of a scenario should not be part of the scientific discussion on this forum unless the entire information is available.

Robert Miller, my sincerest congratulations for being the only one here with your head properly screwed onto your shoulders, and for truly addressing the real crux of the problem. Sure it's easy to emphatically declare "the implant has failed, the implant has failed" by looking at the x-ray. But let's face it, that's no better than the level of a sophomore in Dental school. Without a complete clinical exam, one should never declare anything categorically and emphatically. For example, why hasn't anyone even asked the original poster if the implant is moving at all? And what happened to nuances like "appears to have failed"? How can any professional make a blanket statement based on one x-ray alone and nothing else? That is the height of superficiality! Indeed, we don't know who really is posting this. We take it for granted that everything and everyone is above board, but we forget that on the internet we don't really now who's sitting behind that keyboard, or what their ultimate motives are. A little circumspection would go a long way here, people! Besides, an implant failure after 8 years is not the end of the world. Worse has happened, and does happen. As for those who are so ready to jump on the "sue" bandwagon to loudly proclaim "sue the original dentist" (Elliot Silber being most notable here -- the Dental board? really Elliot?), shame on you all! You're acting way beyond and below unethical! How do you know what this patient (if this really is a patient) did all those 8 years, or what other dentists she/he went to? Or how do you know what her relationship with the dentist who placed the implant is? Did any of you bother to notice that the mesial crown margin is open, creating a retentive undercut and is most likely creating a long-standing food-particle retention and hygiene problem? How do you know who restored this implant, or in what country? Are you even aware of the terribly shoddy dentistry done even in some European countries? Your eagerness to summarily judge the dentist who placed the implant is grossly misplaced; your immediate push for a lawsuit absent all the facts is downright despicable. And your failure to see all the red flags that are raised by her present dentist not telling this patient the proper course of action is incomprehensible. How do you even know that the "patient" even went to another dentist and not the original dentist of record? Regardless, the foregoing notwithstanding, I'm here to tell you all -- and this poster, whomever they are -- that due to the last changes in tort law, that reduced the statute of limitations from 7 years to 2.5 years, a malpractice lawsuit against the dentist who placed the implant is out of the question. Period! And all you who are so eager to jump on the "sue" bandwagon forgot that! One does have to wonder why. Could it be that you're secretly hateful or envious of your colleague because his implant lasted 8 years while many of yours fail sooner? Or could it be that your own pressures have gotten to you so badly that you're eager to see another colleague crucified, irrespective of justice? As for my "esteemed" NYC colleagues, Navid and John Halpern, I can only assume that you guys are having a really hard time paying your office rents, with rents being what they currently are in NYC. I really pity you: you must be so desperately hungry that you're willing to overlook all kinds of risks (and there are many) in getting involved with a case like this. Honestly, you guys need to get out from under the pressure, because it's clouding your judgement. The statute of limitations may have expired for the original dentist, but not for you, and you could be inheriting some nightmare patient. Personally I wouldn't touch this case with a 10-ft pole. Robert Miller is absolutely right: suggestions of cause and effect absent full due diligence constitutes grossly unethical conduct and legal malpractice.

Looks like we have a consensus here: that implant has failed and if it's not mobile it soon will be. Should be removed, which won't be difficult, and the site grafted. I'd suggest an implant replacement, but a fixed bridge is also an option.

In my humble opinion, the implant has failed. Possible causes for this failure are: - excessive occlusal forces due to the cantilevered - magnifier effect: ex cursive contacts; wide occlusal table; - impact of her pharmacotherapy tics, if applicable, i.e., biological, bishphonates - smoking - lack of regulars oral hygiene, i. e. flossing - if cement-retained crown, the presence of subgivial cement

Thanks again for all your comments and suggestions. As noted above in my comment, I was finally able to get an appointment with the surgeon, who from what I understand will be removing the implant. Once again, I really appreciate the time everyone has taken to respond to my case.