Early peri-implant bone loss: normal response?

No removable prostheses, but the distal one has an accidental exposure at the first two weeks. I think was an easy surgery, with no high torque insertion or bone overheating. The thing is I have seen results like this in some cases in literature; thats the reason why im so worried about this response to the bone. Perhaps accidental exposure is something more than negative for the correct healing of the surgery, combined with no smoking cesation patients. Is my first impression for this failure.

If the exposure is small like thin mucosa over a healing head then we just maintain it. If the flap breaks down it could be infection, poor bone quality, or the smoking. I'm also a little nervous over the anterior implant also. The back implant may need to be removed, grafted and try again or use the middle site. Smoking may also be the culprit since it is so hard on healing tissue.Also rule out any medical causes. I would try again but warn the patient that she may not be a candidate especially with the smoking. Do you know how the teeth were lost?

She was wearing a bridge from 34 to 38 With a fracture of the endodontic mesial abutment and of course I extracted the distal abutment too with a big traumatic defect on the mesial side.The rx image show a radiolucency in the mesial implant but is really the defect I could see in the surgery, that can be seen in the orto of the day of surgery. Im following the healing and i think this implant is healing well. Also, this implant is healing in two stage procedure with no exposure of the cap. Thanks for reply the case "CRS", im very worried about complications in my clinical practice that i cant find the reason, such cases like this. Do you think is really an option to graft in a site where a progressive bone lost can be diagnosed?

I think and this is anecdotal but I am finding this complication consistently with failing endodontic teeth. Could you post a preop photo. If this is the case what I am telling my referring docs is to have me remove the teeth since I use my Nd-Yag laser 1064 wavelength to kill the pigment containing bacteria which are sequestered in the bone. It has to be this particular wavelength diode, tetracycline erbium,etc won't penetrate. When the implant osteotomies are cut these bacteria are re-exposed. My protocol is to remove failing teeth or implants and treat with the laser. So far so good, I may be on to something here. The common thread appears to be the failing endo and the pigmented bacteria also the timing on the failures. It can't hurt to graft but if the bacteria are still there the process will continue. The laser seems to do the trick due to the wavelength and depth of penetration which is unique.

Actually I have quite a bit of experience with this. Until root canals were done with a microscope many canals were left untreated so my apicoectomies were doomed to fail in a year or two. Fractures were missed also. Now with 1064 laser I can disinfect the pigmented bacteria which are just under the osseous surface which the hydrogen peroxide won't be able to get to. So you see it is a progression of surgical techniques and understanding the biology of the area not just a mechanical cleaning with a spoon. I don't use antibiotics in grafts it is toxic to new bone growth. So actually my protocol for apicoectomies is retreatment with a doctor who is experienced with a microscope. If there is significant pathology then an apicoectomy. The microscope eliminates untreated canals and patients with unresolved post root canal pain. The laser gets rid of residual bacteria when I remove the failing endo. The problem is when the implant is placed the bacteria are re exposed. So a perimplantitis may develop. Root canals are a great treatment modality when performed under a microscope, you can't treat what you can't see. That's my bias.