Are these implants restorable?
A female patient 61y old came in a year ago with severe periodontitis in the lower frontal teeth. All the remaining teeth were extracted (six of them), and 4 dental implants were placed in the extraction sockets, and primary closure was achieved. The patient had to travel abroad for a period of time, so we made a removable lower denture. Yesterday she came back to do the restoration phase. She did not report having any problems during the healing period. We opened the implants, placed the gingival healers and made intra oral x rays. We were surprised to see that there is a large resorption around all the implants. The resorption is more expressed around the two distal implants. The implants seem stable, and there are no signs of inflamation. What do you think? Are this implants restorable, and what prognosis do they have?
16 Comments on Are these implants restorable?
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Richard Hughes, DDS, FAAI
8/4/2015
Were these implants placed on midcrestal, buccal or lingual?
In these cases where one follows implant placement with a complete denture, it's best to place the implants lingual to the midcrestal position and to burry them.
I have also seen implants that were not stimulated lose bone, in particular Bicon implants. This was a surprise to me, since I had placed many, many Bicons.
Never underestimate the forces of occlusion and pressure upon the edentulous ridge. Remember Wolff's Law!
RonK
8/4/2015
The implants were placed midcrestal, but were not buried deep. 1-2 mm subcrestal.. I suppose the resorption is due to the forces from the denture. We have had other cases with complete denture and there were no signs of resorption, but none of the other patients wore the denture this long (1year).
What I am not sure is whether to proceed with the prosthetics or to remove the implants?
CRS
8/5/2015
Most likely this is the extent of the bone resorption due to the denture pressure. Now the question is do you want to be chasing these implants as they fail? What was the original treatment plan? Locators? Four crowns and a partial ? Of course they are restorable but are they maintainable?
RonK
8/5/2015
The original plan was bar overdenture. The patient prefers to go on with the prosthetics as she does not have any "problems". The soft tissue around the implants looks fine, the patient seems motivated to maintian good oral hygiene. I guess we will wait and see what happens. I am just sceptical about the long term results.
Alex Zavyalov
8/5/2015
I would not be in a hurry to extract the implant now if it is asymptomatic. Try to apply the Locator system, It is less traumatic for debilitated implant-bone correlation.
CRS
8/6/2015
Either plan, locator or bar should be okay if the hygiene is good and the denture well balanced. Hopefully she will comply with long term follow up.
Raul Mena
8/11/2015
I would definitely remove them.
It they were in my mouth I wouldn't want them restore.
Don't buy lame mules the healthy ones become lame, what is going to happen to the lame ones?
Raul
M Montana
8/11/2015
Pretty typical result with placement in the mandibular anterior extraction site, even without the pressure of the denture. The bone is thin, the crest is narrow and remodeling is expected. I request that my surgeons establish a predictable site by removing the boney crest in favor of a broad, flat platform for placement. I need vertical space to build a proper restoration (bar over-dentures need a fair amount of room), therefore hanging on to unpredictable bone crest is counterproductive.
What you are left with is probably restorable provided there is space available (vertically). Usually the bone remodels to where it is happy and stays there. Unfortunately the exposed threads will harbor plaque and good home care becomes even more important otherwise peri-implantitis may develop and lead to further bone loss.
Scott R. Hall, DDS
8/11/2015
Has there been any attempt to control disease in this patient? Just because there are no teeth present, doesn't mean there are not pathogenic bacteria present. Control of biofilm is critically important in maintaining the health of the implants.
Richard Hughes, DDS, FAAI
8/12/2015
Dr Hall made an excellent point. I have seen this with different root forms. From internal hexed, Bicon and Quantum. It's not the implant. It's the microorganisms.
The patients lost their teeth for a reason.
Raul Mena
8/12/2015
Dr. Hughes has a very valid point.
It validates my option of removing the implant.
Remove the implant take care of the oral environment and then place another implant.
What ever brand, those implants are going to be very difficult to properly maintain.
The prosthesis has not even been manufactured, removing and replacing after controlling the oral environment is not such a big deal now.
From the status that they are at the present time, they will only go downhill and you are postponing the inevitable in this case.
Dave
8/12/2015
From the provided PA it looks like the bony level mesial and distal of the implants has reached an equilibrium of sorts, ideally the implants would have been placed at this level after first performing an alveolectomy, this would have also provided adequate vertical clearance for the intended prosthesis as mentioned above
CRS
8/12/2015
I think at placement we are just guessing how much bone will remodel, in an edentulous case I like the tip if flattening out the crest to allow for this. But my gut reaction is an "unsupervised" denture traumatizing the healing tissue. Even when an immediate denture is placed it is adjusted frequently. I would have delayed the implant placement and retrofitted the denture or kept the the denture out during immediate healing say six weeks. Has anyone had experience with placing temporary minis to keep pressure off the healing implants? I see this resorption with flippers and immediate dentures if not relieved. It is hard on the blood supply, healing and hygiene. This much resorption in a small time span is not from perio pathogens! It is the prosthesis.
Krishan
8/12/2015
Hi,I would agree with CRS that the bone loss is primarily because of trauma from denture added to the bone remodelling expected after extraction.The pathogens to cause such a bone loss especially in the implants closed and isolated from oral cavity is unlikely.Though it is going to be a demanding case from maintenance point of view still keeping all the factors in mind,I would like to splint the implants and go ahead with a removable prosthesis provided interocclusal space is sufficient.It is extremely important to discuss all options with the patient
Raul Mena
8/12/2015
Krishan,
I agree with CRS and Krishan, chances are the resorption from it is trauma and not from pathogens, even though pathogens may play a role.
In my practice those implants will be goners.
Rut
8/25/2015
Couldnt agree more with CRS "Now the question is do you want to be chasing these implants as they fail?
