Periapical Radiolucent Lesion Around the Implant: Diagnosis and Treatment?

hi! not sure if there really is a problem. the xrays are quite small but there are some questions you should ask. is there any pus? are there any problems? does the implant sound right when taping it with the back of the mirror? is there any mobility? can you tighten the screws from the healing abutments without movin the implant? generally i would more expect the problem to start on the ridge than on the apical part. we are used to translucent zones apically becaue that is where the bacteriae release their endtoxins. as the implant doesnt have a rootcanal full of bacteriae i wouldnt expect it there. maybe necrosis from drilling but as long as there are no problems...

maybe your implant is shorter than the original osteotomy?

i think there is nothing to interfer as long as the implant is stable and this is confirmed while u torqe the abutnemt to implant and tapping sound .these are clinical as the patient didnt compalin of pain.

i dont think you have a major problem. i believe that its most likely due to necrosis due to potentially lack of internal irrigation.

that seems like you overheated the bone during the osteotomy... if its stable and the crown is working I believe you are safe

A more prosaic explanation for this diffuse radiolucency could be normal anatomy. It does not appear to have very distinct boundaries. The fossa mesial to the canine has a relatively radiolucent appearance under most circumstances due to a thinner total volume of bone. Was there any suggestion of the relative radiolucence at the time of implant placement? I would be more concerned with change over time than with its current appearance.

It could be a remnant of peiapical granulomatous/fibrous tissue associated with the extracted tooth. Again, if the tooth is firm why bother!

The images provided, do not reveal a very distinct area of rarefaction. Assuming an area is present, there may be a perforation into the buccal/labial vestibule. The implant doesn't look very long (about 10 mm ?), but a perforation might have occurred during osteotomy preparation due to an undercut in the ridge. Radiolucency can also result from overpreparation of a site (drilling too deep). If well irrigated during drilling and not accompanied by a perforation through the cortical plate, the latter should fill in. If contact with the lateral aspect of the adjacent tooth root ( #11) was encountered during osteotomy preparation, pulp necrosis could result. The only reason I even mention that is that in the initial PAX's the implant and the root of #11 appear to be in very close proximity. The angulation is quite different in the digital radiographs and there appears to be plenty of space between the two.

Dr.D, Looks like you may have over prepared the osteotomy site. The radiolucent area does not resamble a lesion. If no symptoms can well be left alone but under observaton. Wat

I agree with Dr. Wat above. Over prep of the osteotomy. Camlog is one of very few systems with drill stops will prevent this in the future. Look into that system. I'd leave it. Happy Thanksgiving!

It seems to be over prep of osteotomy while implant placement or may be periapical lesion for the previous extracted tooth. I think it seems ok.

Maybe you need to do a Root canal on your implant ;)

I don't see any PAP. As previously was mentioned that may be your osteotomy was longer than implant that was placed. Usually the most of the times when you get apical PAP and patient feels discomfort on palpation in that area it means that implant perforated the bone at the apex. In your case if the x-ray that you show us has good quality I really don't see any problems. Palpate the apical portion of the implant, if no symptoms I think you should be fine.

It is so called 'burnt bone syndrome' which usually happens from overheating. of course you will know if you over drilled so we are excluding that.also whats sort of time from placement to x-rays. usually resolve on its own i can see you more worried because implant is closed to adjacent tooth but these lesions usually heal over time. best monitored

Looks fine to me from the rad . Time line on the radiographs would be good, good position miles away from adj teeth, i think you should be ok, overprep of the ostetomy is not a problem sinking slightly sub crest i beleive is better. Under prep is annoying as you have to unwind and then re prep etc etc. The rarefaction could be from previosu infection??!

This appears to be a residual granuloma. If you look at the first radiographs and examine the adjacent endodontically treated tooth, you will see a granulomatous lesion at the apex. If this tissue is not meticulously removed at time of extraction and implant placement, the apex of the implant is placed into soft tissue. Unfortunately, this tissue does not spontaneously disappear. The phentotype of the cells present becomes self-perpetuating, with the area potentially growing in size over time. You end up with a classic retrograde peri-implantitis. Treatment is apical surgery and complete debridement. We use an ablative laser (Er,Cr;YSGG, or Er:YAG) to treat the surface of the implant. No graft is needed post-treatment. If you have cleaned the area sufficiently, bone will regrow at the apex. RJM

Was this an immediate placement following extraction of a failed endo?

I think it's all been said, my initial impression is also deeper osteotomy than implant length. But like someone else said above, it's not a problem to go a little deeper, but it is a pain in the butt to wind up a little short. Just continue to eval at intervals.

The only radioluscency I see that seems pathologic is around the neck of the implant fixture. But it improved once the final abutment was placed due to it's smaller footprint as compared to the healing abutment. Some call this platform switching. The other observation is how thin the wall of the fixture is, due to the necessity of a hollowed-out centre to accomodate the abutment. I think this implant can be left alone with a good chance of success barring a fracture due to undue lateral forces on the thin wall of the fixture.