Slight Bone Loss Around Implants: Should I Treat These Before Restoring Them?

You should treat the peri-implantitis before you restore the implants. Replace the healing caps with coverscrew. Disinfect thread, place autogenous bone, membrane and sleep the implants for 6 months before uncovering and restoring.

Hi dear Dr.G It is highly recommended to treat the peri implantitis by opening a flap debride & decontaminate the site meticulously (it is preferred to use laser if available it will guarantee bone regeneration) make membrane supported bone graft & wait 6-8 mounts . but the concern of finding suitable abutment despite of your implants being unknown is still a challenge.

For similar clinical cases the best prosthetic solution is splinted crowns from inexpensive, light-weight materials (without metal frame) such as composites, acetal resins, Lava Ultimate and etc.

Remove impalnts... and replace with Bicon short implants.

First, you can identify the implant through--http://whatimplantisthat.com/ Second, I question if there is any peri-implantitis? As stated the tissue is healthy with no evidence of disease. This is likely the same scenario that we have seen for years with bone loss around the first few threads. Without pre-operateive radiographs or radiographs immediately post placement you really do not know. The #31 fixture certainly is more questionable. Removing, grafting and replacing would not be a bad solution.

Looks like 3i. My prediction is you'll never get bone above the level of #30 distal, no matter how much grafting is done.

I would not treat this as periimplantitis per se. Remove the posterior implant, graft both sites and submerge everything , then replace the implant and at a later date restore Cheers

I bet this was a single stage case and was intentionally platform switched, to avoid crestal bone loss due to the microgap and possibly to compensate for proximity issues. It is possible that bone loss could have been due to premature mechanical loading. It would be good to know the etiology of the crestal bone loss. Otherwise the disease process or whatever, might continue. I would be inclined to remove the distal implant, graft both sites and place another fixture down the line. I would submerge the case and instruct the patient to avoid eating over the healing site. I would also get an FMX, do a comprehensive charting and determine the patient's periodontal status.

Why submerge? At least temporize the implant and let the patient know that it might not work out. Why allow the maxillary second molar super erupt?

Hi, I think Dr. Dan is correct and there is no need of bone grafting and sleeping it for 6 months, and we definitely do not want the upper teeth to over erupt. Have seen and treated such cases and they heal up and work fine. I would also like to add, if we had a clinical picture we could comment and discuss it further deeply and precisely.

If you don't have any signs of peri implantitis and I am almost sure you don't have.All you have to do is restore implants checking the occlusion (smooth touch beetwen upper and lower archs) and an x ray each 3 months controlling the case.

If you have bone lost to the 4-5th tread, before loading, there is a problem. If you restore this case, you have a problem. Better to inform the patient first. The second implant is compromised, better to remove it now. The first one is not ideal also. Question : in your mouth, what do you want your implants to look like before you restore them ? In my hand, I don't restore those in this condition.

Go to whatimplantisthis.com to identify the exact implant. Reflect tissue and de-nature with citric acid, wash area, place dense hydroxyappatite and resuture. Will not get new bone growth but will get tissue integrity and over time pocket depth will decrease. Threads could be removed before placing HA but not necessary. If threads are removed then cut metal must be smoothed with diamond rough and then smooth grit.

If it were me, I would try to restore tissue health first, leave implants the way they are, stable in the bone. Introduce a better oral hygienic plan to patient and replace with either Radica temps and follow hygienic plan for several months. If all's okay, then replace with crowns that fit with broad contacts at the occlusal third of interproximal marginal ridges with plenty interproximal space allowed at tissue level for proxy brush cleaning. Implants don"t look to have undercuts so any good dental tech can replace the crowns once a detailed impression has been provided. Maybe Bruxir crowns as zirconia is very biocompatible to adjacent tissues.I am sure there are oclusal stresses on the #31 implant because of the mesial inclination of placement which may contribute to tissue irritation.

What's happened to this site and where are you people coming from? Again, if an implant has boneloss down to the 4th thread, it's peri-implantitis (please let's agree on that): "If the implants are not mobile, then you're in good shape? Also bonegrafting will do no good?" Do I have to really have to debate this? I think I'm done with this thread.

Dear Dr. G. , one thing I'm sure of .. they are both 3i implants..No doubt.! and in my humble opinion.. all of the above comments could be correct, and at the same time wrong.! . because we do NOT have ( and never will ) enough information to know what is the history of this site, or what happened exactly during the placement time, healing time, and all that.. so..as far as what is the etiology of the Bone losses../ we are ALL speculating !.. as far as what to do with it.. I have done MANY of the above suggestions, if not all.. some will work , some won't.... it may work this time on this case, but not on the next one., or visa versa...but no body knows for sure which one does or doesn't and when . All and all.. doing something to clean the tissue around the implants are better than just watching. good luck.!

I am really concerned about the title of this blog. With 20% bone loss on the anterior implant and 40% bone loss on the posterior implant, this is not "Slight Bone Loss...". I believe that the terminology expressed here is also confusing. We need to first explain the difference between an ailing, failing, and failed implant. Obviously, a mobile or fractured endosseous implant has failed and needs to be removed. An ailing implant is one with less than an ideal tissue envelope but no active disease process (classic peri-implantitis). This implant can go into a steady state and not deteriorate any further. The failing implant is an ailing implant with an active disease process that requires timely intervention to prevent ultimate failure. The presence of mucositis only can be treated with chemotherapeutic agents or soft tissue lasers. Peri-implantitis with considerable bone loss MUST be treated definitively; open flap debridement (preferably with an ablative hard tissue laser) and grafting to restore the hard tissue envelope. Anything short of this type of definitive treatment may result in further bone loss and implant/prosthesis failure. If you restore these implants in their current condition, you not only OWN this case, but you also bear responsibilty for not rendering appropriate care should they fail. RJM

Remove distal Implant. From the post there is no load on these as they are yet to be restored. After graft replace the implant ...I am guessing from the x ray that the bone quality is decent and I am assuming there is sufficient vertical height.Place new distal implant .. Grafting will achieve very little in this case. Then restore both with single crowns If the condition is left and allowed to further deteriorate ie more than the 50% lost on the distal then I don't see why you would choose to restore the distal implant?? If you leave the distal until even more bone is lost then you compromise the possibility of re treatment or possibly damage the anterior... Another possibility is remove distal then restore the mesial and finish right there. Regarding the upper second molar over eruption...possibly slightly extend the lower molar crown distally to prevent over eruption.

I WOULD BE AFFRAID OF RESTORING THIS CASE AS THE NEEDED 1:1 PROPORTION OF IMPLANT (IN BONE):SUPERSTRACTURE IS ABSENT.ONLY AFTER BLOCK BONE GRAFTING TO ACHIEVE THE NESSECARY BONE HEIGHT.

Dear Dr G: I have treated some cases like this and they are quite predictable if the surface is Osseotite. If it is tiUnite you are lost and remove the posterior implant But it seems there are Biomet 3I so do the following: 1. Remove healing caps and place coverscrews and let it set for one month. 2. open a flap, remove the granulation tissue and upon cleaning very well the implant surface apply tetraciclines for 3 min. regenerate with xeno or allograft and collagen membrane and try to close completely the wound. 3. Wait 6 months and you will have a wonderful fase II and you can place the healing cups and restore them. I would be very surprise if it doesn't work. good luck. cheers. Dr R

I think some people are missing an important point in regard to crown to root ratio. Yes, you worry about it with actual teeth with ligaments around them. Implants are different. Osseointegration is essentially ankylosis of the titanium fixture. And there is more bone to implant interaction than ligament to tooth interaction. So you can throw your crow to root ratio ideology out the door with this particular implant.. I have placed and restored 6mm implants with really really long crowns on molars and with occlusion and they still exist in the mouth with very little to no bone loss. However, I have seen teeth crown lengthened and restored with poor crown to root ratio fail. My point is, throw the whole crown to root ratio ideology out the door when talking about implants and implant crowns. It's not the same thing as teeth.

I f the implants are non mobile, tx by way of full flapping, remove all the soft tissue/granulation & fibrous), detox with citrate, graft with autogenous and synthetic (Osteogen) on the outer layer, cover with a slowly resorbable collagen membrane, suture w vicryl. I f those are healing collars, then replace w/ healing screws. Find out if the patient has any bad teeth/ perio and tx. Find out if the pt. smokes or drinks excessive EtOH .

Surely those are 5mm diameter 3i implants with shifting platform (4mm healing abutments are placed) I totally agree with Dr Sam (Periodontist) about the uncertainty of all the treatments mentioned above. I personally do some curettage and sub-gingival irrigation on the first implant and replace the 2nd molar implant

Ideal: remove implant but can be How about flap, prep the implant smooth, and close?

oops I left out: traumatic and may lose vertical bone height

To the Moderator of Osseonews, I am very offended with the unprofessional and extremely offensive remarks that are made by some individuals on this thread. This kind of behavior is distasteful and should be discouraged. It is disgusting to see that some of these individuals call themselves doctors ... MM

periodontal maintenance is also done by yours truly the RDH.... with no JE just how much scaling and probing should we be doing around these frankenstein bolts anyways??....;) sorry couldn't resist...I just wish they had scalers that could actually be adapted to the crazy things since the crown never matches the long axis of the implant.......ahhh well these THREADS crack me up........................................I really need to manage my time better...