Replacement of cemented implant with peri-implantitis?
I have a patient who presents with an implant of unknown brand placed 15 years ago which currently has peri-implantitis. The patient wants the old cement retained PFM replaced with a Zirconia crown and Zirconia abutment. The implant has crescent shaped bone loss to the middle third. The CBCT scan shows a fenestration towards the buccal surface near the apex. To treat the peri-implantitis I plan to debride and place a bone graft with GBR. I am unsure how to proceed with the prosthetic challenges of an unknown implant system. Can anybody identify the implant used? Can you recommend a course of prothetic treatment for the abutment and crown?
11 Comments on Replacement of cemented implant with peri-implantitis?
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michael dds
12/1/2017
Fenestration repair is probably first concern. Re: Zirconia....not sure why pt wants replacement. There is a risk when removing existing crown and abutment. I had case one time where 15 year implant, unknown type, abutment came loose. I cut off crown but could not retighten abutment. Ended up burying implant and placing bridge. So, anyway....two unknowns here....outcome of surgical repair and placing new crown. Options: leave crown as is (safest)...cut off crown and leave abutment, you can still do zirconia crown. Seems like trying to replace abutmentnis the most risky path.
Craig Wright
12/1/2017
So you will be the new owner of the problem! More predictable-explant and graft followed by new implant/abut/crown! IMO
Raul R Mena
12/1/2017
Craig,
Super Smart Advice.
Perioperry
12/1/2017
Yes, yes, yes! There is too much loss of bone and too much deficiency of ridge to warrant trying to rescue implant. Take it out, rebuild ridge, re-implant, then restore. Otherwise you’re asking for a host of problems. Other option would be to explant, augment ridge for esthetics, then do a 3-unit fixed bridge.
J Lee
12/1/2017
It looks like Nobel Direct - one body implant. If I am right, you cannot replace it with zirconia abutment. So I recommend removal and replacement of it.
Richard Hughes
12/1/2017
I agree with Drs Mena and Wright. You can gain height with a bone ring and graft the facial defect with a particulate.
Dr R Y
12/1/2017
Good debridement, 3 to 5 laser sessions for peri- implantitis, GBR, wait for 3 month if you found improvement leave the crown intact if it is functionally and aesthetically fine.
Raul Mena
12/2/2017
Dear Dr R Y
If you do that you owned, and what about the bone defect in the area of the buccal plate.
Have you seen the signs on a Fine Glass Stores?
"If you braked you owned" that applies here.
I do Expert Witness reviews for the DEFNESE and you could be in a lot of trouble by doing the treatment you propose.
Guys, if you want a pet avoid Cobras.
Don Rothenberg
12/2/2017
Remove the implant. Don’t take on this problem!
Remove...graft site with PRF/FDCCB 50/50...4-5 months place a new implant correctly and restore.
Your patient may not like to hear this but it is the only way to get a predictable longterm result.
Good luck!
Barrow Marks
12/3/2017
Can we get down to basics. I see two central incisors a lateral incisor a canine and a premolar that will all need full coverage in the near future. Take out that implant and make a beautiful zirconia bridge. I have been in practice for 45 years I have placed many implants and many more fixed bridges. Most of my fixed bridges are still functioning for anybody who is still alive. Stay away from an unpredictable and bloody affair when you have a sure thing as a choice. You will make your patient happy, you will make yourself happy, you will make your laboratory happy, and you will make me happy. I love you guys.
implantsdr
12/5/2017
Thanks a lot everyone for your valuable advice.
The patient was informed of all risks and complications associated with the procedure to retain the same implant and was also advised for a new implant ,but he was willing to take a chance and gave the consent.
The PFM crown was needed to be replaced not only for aestheics but also as the gross overhangs were probably causing the bone loss.When we raised the flap there was no fenestration but the bone was very thin labially.We removed the old crown,made a new temporary for the prosthetic part temporarily.We were lucky to have a one piece implant with no abutment to worry about .
Thorough debridement of all granulation tissue was done followed by irrigation with clindamycin and normal saline .The bone surfaces were decorticated and GBR performed.
We are hoping for the best and will wait for 3-4 months before deciding to replace the temporary with the zirconia crown.
