Failing Implant: Should I Remove and Graft or Try to Save It?

My case is as follows:

  • Healthy 55 year old male.
  • Jan 2010 – previously infected area(endo failure) ext”’n was grafted sizable buccal defect
  • Aug 2010 – 4.3 by 13 mm nobel groovy implant placed in solid bone (Sorry had film x-rays then but looked fine)
  • Sep 2012 – see current x-ray noting significant bone loss, also buccal fistula present, still no mobility or symptoms

I suspect failure from possible heavy occlusion. My plan is to remove the implant graft/membrane wait 6 month’s and redo. Alternative is to try to save the implant? Prognosis seems poor, though. Any thoughts?

X19486

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20 thoughts on “Failing Implant: Should I Remove and Graft or Try to Save It?

  1. May have something to do with the surface of NB so I hear , whilst you can treat if you wish may be best to remove with a Neo Biotech reverse torque machine and place another surface type after grafting.
    Peter

  2. CT scan is the first thing I would do to assess how much damage is present and what should be the course of action.
    Flap less extraction, disinfection and bmp with mfdba would be the least invasive and predictable tx.

    Sam Jain, DMD
    Center for Implant Dentistry
    Fremont, CA

  3. the apex is intact in radio ,with a graduation of bone loss more radially indicating 1]improper clearance 2]tfo,3]crestal loss from begining of crown placement,, but but A CBCT is a must to asses the loss, b] atraumatic removal is the NEED OF HOUR without flap or minimal invasion, c]then if ur going for graft wait for 6 months for propre osteoclastic activity n make periodic folw up,d] inbetween chek the INTERFERENCE in occlusion if any from proper cast mounting ……thnx

  4. BTW, what implant cement did you use. there are implant cements that are not radiolopaque so a cement problem will not show up on X-ray. did you deride the peri-implant pocket.

  5. Traumatic occlusion? Possible. Margins of crown on a stock abutment deep below tissue with probable cement extrusion and inflamatory peri-implantitis? Highly Likely. Removal and GBR is the only option. Secondary hard tissue grafting may be needed. There is no reason to do a scan before removing the implant. Attempted salvage will only compromise the site further and endanger the adjacent teeth if more bone is lost.

    There is no excuse not to use fully custom abutments or screw retained restorations in todays world. They are vastly superior esthetically and biologically.

    • Hi Greg

      Your comments make the most sense of the ones I’ve received so far. Would you flap remove the implant and graft all in one setting ? That is my plan and I’d like to get going on this soon.

      Thanks

      Brent

    • There are several reasons to not use a fully custom abutment. One of them, choice. You have a valid opinion. However, thousands of successfully restored teeth show that it is not necessary to use screw-retained or fully custom abutments. It is not a standard of care and it probably won’t be.

      Remove the implant, graft and start over.

  6. Check the health staus of the molar #14 ! Very likely a failed RCT tooth, looks like MB2 canal is missed.It’s the most common failure of RCT tooth on the first molar. It’s the most probable cause of the adjacent ailing implant ! stick a gutta percha through the buccal fistula , most likely it will lead to the mesial bucal root of the adjacent molar.
    I would make sure the adjacent molar is in good health before attempting to save the implant. Trust me, I’m speaking from experience.

  7. I would regraft and reimplant the case since more than half of crestal bone has been resorbed. Shouldn’t be hard to take it out.You’ll get a lot better result .

  8. Hello Brent

    Absolutely no flap. Your eyes should be looking for 3d view around the problem and not the traditional 2d. You can design your surgery much better with pre-op CT.

    I do this kind of work every day in my center.
    I redo lot of implants placed in neighboring Mexico. CT scan is the FIRST thing you do for diagnosing the problem

    Unscrew the implant , do the clean up, place bmp with MFDBA, slight piece of collage as a lid over the graft , figure 8 suture with vicryl 5/0.

    The gingival tissue should not even know that you removed the Implant and placed the graft.

    Sam Jain, DMD
    Center For Implant Dentistry
    Fremont CA

  9. you’re missing most of the buccal plate from the start or you over torqued implant.. remove implant, graft and wait 4 months and then place another implant. always open flap to see your buccal plate before you start drilling and remember more torque is not better !! good luck.. i’ve had a handful of this cases

  10. If there is significant loss of the buccal plate I don’t quite understand how a non-surgical procedure is going to be successful in regenerating this prior to placing another implant.
    DrT

  11. This again is a graft failure. You did everything correctly except for your selection of graft material. You did not state what graft material you used but it is non resorbable and as such you put your implant in inert material that broke down over time. Nothing wrong with the occlusion or the implant placement or the implant itself. This is a straight forward graft failure. Let me know what graft material you used and I can then advise on a course of treatment. Greg Steiner Steiner Laboratories

    • Hi Greg,

      The graft was done about 6 month’s before placement by another dentist colleague of mine. It began as a failed endo. He used mineross which is an allograft. Ironically I feel this failure is related to the graft like you as I have never seen one go this way in the absence of any other reason. I think it was well placed and properly loaded.
      I removed it last week and while it was still solid there was significant bone loss radially to at least half way down with the same amount of thread exposure.
      I trephined it out ,curreted it ,decorticated to ensure bleeding and placed 50/50 cancellous /cortical allograft from citagenix. I plan to go back in after 6 month’s of healing and at 6 month’to place another implant. All at my expense of course :).I Look forward to your feedback Greg and that of the others on this helpful forum.

      Brent

    • DrT
      Please don’t be offended but there was no need for assumption here- there is remaining sclerotic bone at the apex and only nonresorable grafts fail like this. If this was a resorbable graft material this would have not failed because the implant would be in functional bone. For more info please refer to the following post to Brent. Greg Steiner Steiner Laboratories

  12. This radiographically looks like peri-implantitis. If it is not mobile I would flap, debride,decontanimate, and place a membrane or graft. Tell the patient it is failing and you will try to get some more time out of it. If you can remove it easily the do so and graft it. The hard decision is do you place another implant since originally there was infection which probably caused the implantitis. I don’t think I’d roll the dice again.

  13. Hello Brent
    Allografts and xenografts produce sclerotic bone. The healing process is due to an inflammatory response to a foreign body. When the graft is placed osteoclasts migrate to the area to resorb the material but when they contact the antigenic material the osteoclasts disappear and abnormal osteoblasts arrive and encase the graft material in mineral resulting in the graft material encased in mineral often with no cells and few to no blood vessels. Because the body cannot resorb the antigenic material, it encases it and walls it off from the rest of the body resulting in sclerotic bone that is essentially inert. Allografts being resorbable or osteogenic or osteoinductive is a nice fairy tale. If you want to understand how allografts and xenografts heal and fail, go to our web site and click on the publications tab. Read the two photo essays on allograft and xenograft histology and then read the essay on sclerotic bone which documents with photomicrographs and electronmicrografts on how sclerotic bone fails. If you want to see how a true osteogenic bone graft heals read the photo essay on Socket Graft Putty histology. Back to your case. Didn’t you find it odd that you had a blown out lesion and you needed to perforate the walls to get bleeding? If this implant had failed as a result of infection there would have been perfuse bleeding. You needed to perforate the walls because you still have some sclerotic bone which is nonvascular. This implant failed because it was placed in sclerotic bone produced by an allograft and now it has again been re-grafted with an allograft. First, you cannot get bone to grow over sclerotic bone because there are no cells or blood vessels so my suggestion is, that you remove the recent graft and remove any remaining sclerotic bone from the initial graft. You can see sclerotic bone because it does no bleed and cuts like chalk. After you are back to normal bleeding trabecular bone then graft with a resorbable graft material that will produce normal vital bone that will integrateh to your implant and respond to changes in load over the life or the implant. Greg Steiner Steiner Laboratories

  14. I am not offended but thank you for your consideration..I think we…or at least I know I am…are all here to learn. Thank you for taking the time to give me a thorough explanation.
    DrT

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