Should I be concerned about this implant?

The details are not clear - was The sinus lift done at implant insertion? What tooth exactly? Pre-treatment x-rays? What’s the time frame? X-rays over time? Clinical appearance? Signs of infection? Lower left corner of what?

Unfortunately this is not an ideal situation, and may lead to further problems in the future. We have not seen the original xrays and it is not fair to condemn the dentist who did the work. In my opinion, I would remove the implant… wait a month, have the site grafted to rebuild the bone....wait four months or until the bone has been rebuilt, and then replace the implant in an ideal setting......

the angle of the implant is horrible.

poor placement due to being too mesial and angled with funneling bone loss present. Best treatment would be explantation graft and place a fixture centered in the space and vertical. If this was placed by a specialist I would talk to them indicating the problems related to placement and suggest they correct it at no cost to the patient.

The patient should decide which way to go. If one gets some time from this implant and crown it will take him to a a later point in life. There is always a chance of failure on redoing and as long as it does no harm it could wait. If you can guarantee very long term success , redoing may be an option.

Anybody that has placed a few hundred implants will have some that wind up at the wrong angle and/or will have some bone loss. Certainly this could be performed better yet I wonder do want it the best it can be or can you put up with the problems you have now? It would be nice to see a longer implant that had a bigger diameter which would increase the support and decrease food collection. Talk to your dentist to see what options he would consider and then decide if his attitude about the quality of the result matches yours.

There are many issues to consider in this case and to be honest you post is a little confusing. However I understand your concern. My advice is to go to a specialist dentist (in this case probably a prosthodontist would be the best specialist to talk to, but possibly a periodontist would be acceptable – albeit that most of the questions you raised are prosthodontic issues). To answer you overall concern, yes there is a need to get further advice as to what you should do.

The angle of the implant is a definite issue. Other is the osseous loss that is occurring. This could be related to the horrible angle on the implant. I agree with Dr. Rudnick....Remove the implant, Graft and allow heal time. This is your best bet. Hey, if you have done enough implants, and I have placed over 10K, angulation errors occur. But trying to be heroic usually does not work. Best bet....start over. Neil Zachs Periodontist, Scottsdale AZ

How can one based on personal opinion suggest removing the implant, etc. Claims of detrimental sound like words from heaven or hell. Should Pisa Tower be destroyed and rebuild. For someone who lives in the States and visits a dentist with some reasonable frequency, the condition will provide the answer. The patient is the sole person that can determine what if anything needs to be done. The so called experts need to stop and think if they treat people or are ingaged in an art project. Would a tooth that developed in the same position need to be extracted by the subjective opinion of a dentist? Without doubt there are plenty of teeth in position like the implant and I was there and I witnessed it.

Well I haven't placed 10k implants, only 8k! Anyway, the problem here as already stated is the bone loss will continue and involve the mesial root of the distal tooth. The adage of every doctor (dentists included) is first do no harm. At this juncture the implant could easily be explanted with reverse torque. A graft of this shallow a defect is highly predictable. So to prevent further harm the implant shuld be removed, the site grafted, and in 4 months a new one placed. There is nothing sacred about a specialist. Most of the implants on the market today were invented by GP's, not specialists. A GP with adequate training is quite capable of doing all these procedures. I would advise you to speak to the dentist (be it a specialist or GP), tell them you are not satisfied with the outcome, and ask to have it redone as outlined here. In my office at least there would be no charge for this procedure.

Remove the implant, graft the site use prf in mix, re evaluate on craft 4 most. If less than 6 mm of bone in sinus floor will need lateral window approach for sinus graft, use prf in graft mix.re evaluation on ct at 4 most. Place new implant. If more than 6 mm of Bone is in the sinus floor can use a crystal lift with simultaneously placing the new implant . Restoration should be easy.

Angle of the implant is so off it almost looks like it may be touching PDL of the mesial tooth. This is a very simple, single unit crestal approach sinus lift and implant placement case and I’m not sure why the implant angle is so off?? What a mess. Maxillary angled implants in the posterior have the highest failure rate, then on top of that, a stock abutment and an ill-fitting crown and packing food. Not to mention we have no idea what the kertinized soft tissue looks like around the fixture. Best time to remove the implant is before it fails catastrophicly resulting is severe bone loss and a more compromised situation. I would very carefully remove the implant, use a restrictive surgical guide to perform correct osteotomy, place new implant in corrected position- flat cover screw, graft the defect from the removed implant, GBR, primary closure, 2nd stage uncovering surgery and soft tissue graft if needed, then restore with gold hue titanium custom abutment and eMax crown when it’s all healed. Bam.... done!

Tom (1) Don't waste your money on a CT, it's clear from the plain x-ray that this is not an ideal situation. (2) I hope you weren't charged extra for the sinus lift. The implant is below the sinus floor so the graft is contributing nothing to the retention of the implant and was a pointless exercise. (3) The implant fixture is very badly angled and I imagine was placed freehand without a guide. However, implants are fairly forgiving and this one will probably survive a fair while and I wouldn't rush into having it removed. My main concern would be with your difficulty in maintaining oral hygiene. If this is a constant problem something needs to be done about it. Probably a better contoured crown will do the trick. I suggest (1) Go and see another implant dentist and ask for a written report. (2) Return to the original dentist, show him/her the report and ask politely for a full refund and the cost of any recommended remedial treatment.

While it may seem somewhat primitive, I ALWAYS place a titanium “dummy”, same size as implant without threads, and take an x-ray before even opening the implant package. This completely avoids “surprises “ after implant placement. One knows EXACTLY what the final result will be. One is CERTAIN of the outcome.

The deed is done, and I’ve seen worst. My most practical advice, with the patient ‘s wellness in mind, I see two options : A. Unscrew the crown, reflect the flap, debride , etch and laser the implant surface. Graft the pockets with emphasis on the distal of the natural tooth ( bicuspid) place a membrane. Achieve primary closure. The intent is to regenerate bone level implant. Once healing is complete, re design and deliver a new crown with ovate relationship to the tissue. This should eliminate food packing. B. Remove implant and start over. Ultimately, let the patient decide. Good luck.

Update: Requested a second opinion from a prosthodontist and they suggested seeing the partner of the dentist who performed the implant, who was also a prosthodontist. Met with the partner, discussed my concerns, and he read all of the comments posted here. His responses were that dentists on the internet are trying to inflate their egos, the implant was angled because that was where the most jawbone was present and the best spot for the implant, there are no concerns regarding lack of bone surrounding the implant because he tapped on it and didn't see any movement so it is extremely stable, implants in this area will always have area under the crown exposed, only floss up and down and don't floss near the abutment (preferable use a floss pick), and flossing near the abutment can cause gum loss. When I asked why his partner told me after placing the crown that this tooth was an 'audition' and not to chew anything hard or tough like beef jerky on that side, he paused for a moment and said he would have said the same thing because placing an implant in that area of least jawbone, does require some caution. He did offer to do another crown with a 'custom abutment'; not an angled one but a custom one. (Not sure what that means.) So, I will still get a second outside opinion, but how do you decide who is right and who is wrong? I even wondered if both of these dentists could be right and there should be no concerns regarding the implant. Am very interested in your thoughts.

Mr. Schleis, Nobody has a crystal ball to predict the future. Implants perfectly placed (based on an radiograph and visual observation) fail. No matter how many implants one has done and no matter of the span of time in which one has been placing implants, there is always something that nobody understands that causes a problem. There are people walking around with chronic headaches and doctors have no clue why . If you are doing well, do your best on your end to maintain the implant (meaning keeping your mouth clean). With dentists is like with gambling, everyone has an opinion but nobody knows for sure. The fewer contacts you have with them, the better you will do. Believe it or not, I am a practicing dentist.

I would like to thank everyone for your comments. I still have some trust issues with the dentists involved here, and intend to get (hopefully) a better crown and follow closely with my primary dentist whom I do trust. The surgeon who did a cervical (C5-C6) fusion on me reacted the same way when another surgeon said it had not fused properly. The hardware finally broke and it was back again for another surgery. I think history will repeat itself, but will see. At least I know I need to follow this closely.