Subscribe!
Implant Abstracts
Implant Cases
Ask UsFailed Bone Graft?
« Exposed Dental Implant | Adverse Reaction to Dental Implant Materials »
Lucy, a dental implant patient, asks us:
I had a lower left molar extracted about 2 1/2 months ago. A bone graft was done at the time using synthetic graft material, in preparation for a dental implant. The dentist also put a membrane over the graft. The tissue over the extraction seems to be healing very slowly.
I can chew on it, but this seems to stir up some of the graft material under the tissue and causes irritation. I can feel and see a piece of graft poking under the tissue. Even when
I don’t chew on it (which is most of the time) graft particles seem to
irritate the gum tissue.
I asked the oral surgeon 2 weeks and then 5 weeks after the surgery and
he said don’t worry, you are healing slowly but it will heal and you don’t need to see me again for 4 months.
I have a couple questions because I am not sure I am getting the full story:
1)Can graft material slow down the healing of the gum tissue by irritating it?
2) When should I expect the gum tissue to have filled in? What will that prevent me from feeling any graft underneath it?
3) How does the surgeon know if a graft has ‘failed’. Does an x-ray
have to be taken? What do they see that tells them whether or not it
worked?
4) What’s involved in removing a failed graft? I am leary of getting
the dental implant now and may just want to not do anything at that spot–but
I want this irritating graft material gone if possible.
I would appreciate any answer to the above question. Thanks.
Featured Sponsor
Free Daily Email Alert Click Here>>
Get OsseoNews.com Comments delivered daily! Click Here to subscribe.FREE Weekly Email
Keep current on the latest dental implant discussions! It's Free!
>>Click Here to Subscribe to OsseoNews.com Now!
-
Hot Topics
-
Editor Picks
-
Patient Issues
- Cone Beam CT
- Mini Implants
- Bone Grafting
- Oral Bisphosphonates
- Sinus Lifts
- Implant Complications
- Immediate Loading
- Overdentures
- Nobel Biocare
- >>See All Main Topics
37 Responses to “ Failed Bone Graft? ”
Lucy:
It is difficult or may even be inappropriate to offer medical or dental advice without knowing all the facts, so the following are my response in general terms.
1. Yes, graft material may slow down gum tissue healing, especially if the graft was loose and not well organized by a stable blood clot.
2. When the gum is healed over the exposed graft material, you shouldn’t feel the graft. It is difficult to know when the gum tissue would feel in. It depends on what is going on with the graft material.
3. Some signs of a failed graft are: exposed graft, lost of large amount of graft material, pus, drainage, or grossly reduced volume of graft. X-ray may or may not show if the graft is being taken well. The surgeon would look for the absence of the above, the gum tissue characteristics, and the x-ray. The moment of truth may only come at the time of implant placement when the gum tissue is opened to expose the grafted area.
4. It usually involves giving you some local anesthesia and scraping out the graft material that looks like not being accepted by the host bone.
Good luck
1st you must not chew on grafted site.
2nd the gum most of the time going to heal after the membrane is removed
3rd as previously mention the best time to see if the graft took place is after exposing the area
4th if graft did not took place the area will occupy by soft tissue.
Dear Doctors: Is it possible to remove a dental implant that has integrated with the bone? I’ve had this implant for about two years now and it is causing me pain. Thank your for your attention.
It is possible to remove integrated implants. The dentist must use special trephine bur to retrieve this implants. If you have pain you must see your dentist and explain that to him or her. If the pain comes from implant directly its usually considered to be failed implant, and something must be done. It is very difficult to judge without seeing what happening. But you definitely must see your dentist end explain what is going on. May be this not the implant? may be the crown that causing a lot of pressure? check with your dentist. All the best.
Dear Dr. Amayev: Thank you for your response. It is comforting to know that removal of implant is possible but I worry that the pain will not go away. I’m also concerned about losing a lot of bone and possibly healthy adjacent teeth. Once again, thank you for your response.
A preferred method for removal of failed implants is the Er,Cr;YSGG laser. It’s advantages are:
1. It does not heat up bone
2. It will not contaminate the site with titanium debris that can cause foreign body reactions
3. Because there is no coagulative effect, an implant of larger diameter can be placed immediately or the site can be grafted without fear of latent infection because of the bacteriocidal effects of laser therapy.
We stopped using trephines years ago and have also had excellent results with this wavelength treating peri-implantitis (published studies). The erbium based laser has replaced a significant part of our traditional surgical armamentarium in oral implantology.
Dr. Miller: Thank you for your response. I will inquire as to whether or not laser surgery is available for implant removal. Really would love to save the tooth next to my implant as it is in really good shape. Also, the less bone I lose the better. I realize, however, that this is probably an impossibility. Thank you again for your time. Sincerely, P. Lovett
Bone graft was put in after wisdom tooth extraction. Severe pain resulted. Dentist would not help so I had to try and find someone to remove. No one wanted to touch it. Was put on many antibiotics, did not help. Finally a year later it was removed. I still have much pain but not as bad. This has been 2-1/2 years ago. Will it ever go away?
Please someone respond! I had a complete upper ridge bone graft more than 6 weeks ago. The entire right side tisseu has opened and the bone is exposed, jagged. I see the titanium tacks. My face feels tight. The middle of my ridge appears to be starting to open. Help. At what point is this considered a failure. Please answer!
Karen, you need to go and see your surgeon ASAP.
I am under the care of the oral surgeon. I had the first 6 weeks ago, a second 3 weeks ago as bone began to be exposed. Now tomorrow I’m having the 3rd as everything has opened on the right side. The surgeon keeps saying it will “granulate over” which hasn’t been successful. My question was when is this considered a failure?
I’m sorry I didn’t clarify the previous comment. Because of abuse at age 12 I had several of my upper teeth removed. That was 43 years ago. Then because of problems the remainder uppers were removed 35 years ago. That’s why to extreme bone loss. I had the original graft (Hip) 6 weeks ago. Then after 3 weeks the surgeon had to (under anesthesia) remove or scrape some of the newly exposed bone. Tomorrow I’m having a 3rd surgery as the entire right side ridge has opened and the bone is exposed again. Painful as well. My question is: when is it time to say this has failed? The surgeon says it will “granulate over” & heal. Have you heard of this? Last week the surgeon said I was in an uphill battle. Do you have any experiece in this? Information? Thanks for whatever you can tell me.
Hi karen,
it seems like the graft itself is probably contaminated or infected or necrotic(it has probably became a source of a chronic infection). The curettage is done in cases of necrosis to remove the necrotic tissue and induce bleeding.
It happens some times in smokers, diabetic patients, patients with coagulation problems, also when primary closure is not achieved or when the stitches open for some reason before healing is completed.
Be patient since you may at the end have enough tissue to work with and do the intended job!
The best you could do on your side is to rinse the area with salt water.
on the other hand, you could get a second opinion with somebody else in your area since it is hard to talk of a case without having seen the patient and clinical history.
I am dentist practicing in implants, my last implant has come out 45 days after surgery , with out any thing indicating a failure implant within this period
could you please help me a bout the possible reason
thank you
By the way,consider changing your system into a more established, sophisticated one.
I had a bone graft done 2 weeks ago in preperation for implants. Today I was rinsing my mouth and the collegen membrane the oral surgeon placed over the site started to fall off. Its not completely off but is partially hanging down and is very annoying. It is friday night and the office to my oral surgeon is not open until monday morning and I am not sure I can deal with it hanging until then, The site dosnt hurt or look bad etc besides the membrane seeming to come unstitched. What do I do, and is this a serious problem?
I have had two bone grafts, both of which have failed due to ‘exposure’ of the graft material. In fact, a doctor who has posted on this site was the surgeon who performed my grafts. I am young, healthy and a non-smoker, and there is therefore no obvious reason for these repeated failures. Every Dental Implant specialists I have seen since the second failure has claimed that the synthetic material he used, (THC or TCH?), really hasn’t been used since the 1960s and that this is most likely the cause of my graft failures (as the gum has been unable to close over the synthetic material and my body has not been able to form blood vessels through the synethetic material). Is it the mark of an inexperienced surgeon to use synthetic material in a bone graft in this day in age? Any comments would be helpful, Thank-you.
I forgot to include that the bone graft was supposed to be in preparation for an Implant to one of my upper very front teeth.
Oh, and I apologize, the material used is TCP not TCH
Please help. I had an implant placed six years ago due to a loose baby tooth with no adult tooth underneath. Everything was going fine until 1 1/2 yrs. ago, when the crown started to wiggle. My dentist sent me to the periodontist, who decided to drill down into the crown to determine whether it was the crown or implant. I’m not sure what that was all about, except that the drilling was extensive and the pressure was incredible. Ultimately, the doctor destroyed the crown and broke the head of the screw. He determined it was not the implant, but the crown. A new crown was made, and was stable after being fixed. A month ago, I was at a cleaning, and through x-rays and probing, found that I had bone loss around the implant–diagnosed as failing. Could this recent late failing be due to the pressure from the drilling? The doctor has cited me no causes whatsoever. My periodontist has now done a bone graft all around the implant. I have been in much pain for an entire week since the surgery. The pain is now subsiding, but it is severely uncomfortable to chew, and the toot next to the implant seems a little loose. Could this be a result of the bone graft? Will I ever go back to not noticing the implant? Thank you for responding.
failed bone grafts are always the postrequisit of the undue masticatory loads being put on to the graft area within 72 hrs of the time period. so the moral of the story is that not only the graft placement is important but the postoperative instruction and patient education stands equall importance. thanks
Hi- I am 3 weeks post op on a bone graft on my upper right premolars. During the last couple days I have noticed increasing amounts of graft material coming out- how much is too much? My perio said to give it one more week and see if it heals- it has been half a week and it has gotten worse. Any suggestion on what I should do? I have an appointment in a few days, but am I in danger of losing the majority of graft material? I’ve got a flipper which I am keeping off. I am moving back to less solid food (even though I was eating very gingerly to avoid using that side). I am also avoiding wearing my night guard in case it somehow disturbs the area. It just seems to be getting worse.
I am a 43-yo healthy, non-smoking female who has had a dental implant on my I-9 tooth. The implant was completed late May this year and the dentist has not set up any post examinations for follow-up after me paying close to $7K … except for wanting me to come back and replace a few silver fillings, which I will see a different dentist to do these since he he quite costly. I am surprised that at the expense I paid a few follow-up visits are not included in the “price” seeing that everything is fine. I write because things are not fine. About 2 weeks after the permanent crown being placed I have had an ongoing infection right above the tooth in my gum. The gum has had a small bubble right above the tooth, which seems to calm down after I brush and gargle with the clorahex (sp) rinse. However the swelling above the I-9 has not truly ever gone away … the bubble comes and goes. Twice the little bubble exuded pus … which after a good brushing and rinse I thought was a good thing and would now heal. Yet the gum area is still quite swollen at the very top portion of my gum just under my nostril (the roof of my mouth in this area seems ok). The dentist did do a bone graft with a synthetic material at the time of extraction which was last year about this time. During the 7-months of the implant process when the gum would bubble up the dentist said not to worry. Recently, a periodontist friend visting from Sweden said that it could be bits of the bone graft coming out. I am getting quite concerned but walk around in silence as when I smile the swelling is not noticeable. The implant seems firm and looks beautiful … but something is not quite right. I heard that the clorahex can stain the teeth blue, so today I bought some Hydrogen Peroxide to gargle with to hopefully help heal the site. I am not on antibiotics or medication of any any sort. Thanks in advance for any advice. I’d rather not go back to this dentist and clear up the infection on my own … but maybe this is not possible. ~ darlingdd
Hi, please someone advise.
I have had a bone graft to the upper front teeth. I have also had an implant on one of my rear molars.
After much time and expense, my dentist now feels that my implant may be failing on my front tooth. This showed up as slight darkening around the implant site on x-ray, but I feel no pain or movement.
What are the procedures for correcting this, and how likely is it that I may not be suitable for implants in this area?
I am a 42y/old non smoking male.
Thanks
darlingdd–
There is a thought that what you are describing is cement from the crown not being properly cleaned around the neck of the implant after seating. This is something you should seriously consider, if it proves not to be a bone graft material coming out.
Just a thought!
Thank you, Karen … The hydrogen peroxide seems to be helping. Perhaps this is my fault for not brushing fastidiously enough. I have a sonicare toothbrush and brush my teeth at least twice a day, and don’t gargle typically except for when the gum has been quite swollen. The smell from that part of the gum is not pleasant when I poke around with my fingers massaging the site compared to the other areas of my mouth. Hopefully it will heal soon and I hope if it was due to my delinquancy that I have not caused too much damage.
PS: The days of all my parent’s dentist friends from Loma Linda University (mostly Swedes) is now over and I will miss their expertise as I am now coming into the age where I need to focus on maintaining healthy gums … I felt confident in their guidance, always, although the dentist who did my implant was referred to my mother by the doctor who did her implants in Newport Beach. Sadly to say, I think he is more driven by the money than the people who actually create his livelihood … to me there is a major unbalance there.
I appreciate your thought very much.
Thank you for responding.
~ darlingdd
darlingdd —
more thoughts on this — I know you don’t like using the chlorohexadine because of the staining, but that is really from prolonged use. If you use it on a q-tip and just rub it in the immediate area, it can really help. Especially if you have a bad taste coming from the area or foul smell. It sounds like something that needs to be addressed or you run the risk of losing your implant.
I have seen a lot of research on the cement issue. It was mentioned at the Nobel Biocare conference this spring as well.
I hope it gets better for you! Goodluck.
Karen (by the way, I am an Implant Coordinator)
I had 4 implants and a bone graft on the right upper side. For 3 weeks I was in pain and the gum was swollen and infected. Today, an inplant came out. I went to the surgeon and he removed the others and stiched up the gums. What do you think happened and can I get future implants or is it a hopeless case? The bone graft material was bovine and my blood.
I have 4 implants upper right and bone grafting with bovine/human. I got them 3 weeks ago and the entire time was in pain. I was given narcotics etc and told to rinse. Today, an implant failed and came out. I went to the Dr. and he removed the other ones. Am I still able to get implants in the future when the infection clears?
Does bone graft material, either synthetic or cadaver bone, show up on xrays?
Dear Friend,It was really nice to read your comments.I am a general dentist practicing implants.I have a case of a 3implantsupported baroverdenture.Now after a year both the lateral implants show improper osseointegration and look failed.What should I do in such cases.Kindly comment and advice on my email. Also comment on the best possible Graft material for an atrophied maxilla 2.5mm size on the calipers to be followed up by implants.
Awaiting a speedy reply.
Ambrish Maniar
hi, i had 2 dental implants about 2 weeks ago and i had no problems, but one of them is not taking as well as the other, the gum around one is not growing very fast and has left the bottom of the implant exposed, also it is slightly’wobbly’. I?t moves when any pressure is put on it. is this implant failing? or is the bone just not grown backa round it yet? please reply
Hi. About 5 months ago, I had a bone graft from my own lower jaw bone in prep for an implant on my upper lateral incisor. However, this site has not healed, as I can see the bone and the screw used to attach it. The site doesnt hurt and doesnt look infected at all. Could I be simply healing slower than normal or should I be concerned that this graft is a failure? Thanks
Hello all, I had a cadaver bone graft installed in the top front of my mouth 4 days ago and was sent home with limited narcotics and no antibiotics at all. Just the peridontal rinse. I have developed a nasty taste in my mouth that almost makes me want to gag. The pain has lessened a little and the sweeling in my face has amost completely gone away but this taste is new. Does anyone have any idea what I should do. I live 4 hours away from the dentist who did the work.
Thanks,
racefan1965
Having placed implants since 91 I have seen a few things and how to deal with them but reading the above comments is scary. These are all issues GO and see the surgeon as things cannot be rectified if he does not know about it.
PF is right! Go back to the dentist/surgeon who placed the graft. He is in the best position to help you at this point. Don’t get confrontational or condemnational. At this point it’s not warranted!! Keep in mind that complications and problems do arise despite the best of efforts. Lastly if you haven’t learned this yet: There’s no garuantees in life! At least not in this one! from Man O’ Steel A “Fellow” Dentist/ Prosthodontist 28 yrs. Fellow of the International Congress of Oral Implantologists
My sister recently (two weeks ago) had oral surgery that included grafting bone from a cadaver. The surgery was performed by a highly-respected oral surgeon. She was sent home and within days had complications of swelling in her whole body, pain in her joints and more recently, severe head pain. She has been in a regional hospital for over a week and they still do not know what is wrong. They have since extracted the bone graft but she continues to suffer with severe pain in her head and neck area, and finds it extremely difficult to walk. She is on Prednizone to help with the inflammation and taking morphine for pain. Most are in agreement that her condition is caused by an infection from the bone graft. They have taken tests upon tests, including AIDS, West Nile Virus, Lupus, Rheumatoid Arthritis, and just about anything else that may be a cause for her illness; all tests coming back negative! Please offer me and my family some answers as we are all hoping for a recovery soon. She has been hospitalized for over a week and they can’t seem to do anything for her…please advise. Thank you, Jim in Montana! (June 26, 2008) P.S. Tomorrow is her birthday!
Leave a Comment
Note: Please refrain from ad hominem attacks, and promotional comments. Outside links are not permitted in comments. Though we require an email to route questionable comments to our editors, we will NEVER publish your email or use it for any other purpose. Thank you for your understanding.
Note: At times your comment may not appear on the website immediately, because it has been sent to our editors for approval. Once approved, we will publish the comment. There is NO need to resubmit your comment, if it does not appear on the website immediately.