Multiple Failed Bone Grafts

Yvette, a dental implant patient from New Jersey, asks us:
My periodontist suggested to have a bone graft done before any dental implant placement. When I went back after 4 months, he told me that I lost a lot of bone after he was doing some drilling, and that he has to do another bone graft.

Another six months went by and I went back again. Finally he was able to insert the screw. He then asked me to come back in two weeks for the temporary crown. However, when i came back, he told me that the screw was a little bit loose that he has to do another bone graft for the 3rd time. I took all the necessary precautions such as eating soft food, no pressure on the site etc. Why does the bone graft keep failing? What are the chances of this 3rd bone graft being a success? What should I be asking my periodontist? Thanks for any help.

13 thoughts on “Multiple Failed Bone Grafts

  1. Dear Yvette,

    The success of the graft depends on basic surgical prinicples which guide the practioner for the best chances at success. There are many more, here are the major points.

    The first variable is your age and general health. If you are in the advanced years of life, the bone quality is much more cellular and less dense. Your health, such as diabetes, hypertension, previous radiation and smoking do play a significant role is whether the bone graft is successful. If you are in relative good health, it may be other causes such as the following.

    The graft also depends upon the type of bone used (whether it be your own, another human’s bone or animal bone), and the location within the oral cavity in which the graft was undertaken (upper jaw has better results than the lower jaw generally). The health of the surrounding teeth and the condition of your gums are also contributing factors. All these factors individually may not influence the graft success, but combined can determine the success or failure.

    I do however disagree with your periodontal surgeon, that if an implant becomes loose, which is one of the signs of failure, a third bone graft is not likely to save the implant. Find a reputable, well-known as trustworthy clinician who has experience with implants and bone grafting (usually periodontists and oral surgeons) and obtain a second opinion.

  2. Yuvette,

    SF OMS has given you good advice. Time to get a second opinion. The definition of insanity is doing the same thing more than once and expecting a different result.

  3. First of all, going back to a bonegraft site after 4 month seems a bit short. This is even more true if the bonegraft is in the upper posterior area of the jaw.

    Without knowing which tooth it is that the implant was placed it is hard to say why your implant became loose. however having said that, after only 2 weeks after your implant was placed,and to determine that it is loose and require more bone graft, just doesn’t make sense.

    For an implant to fully intergrate, it requires different timing depending on where the implant was place. General rule is upper maxilla esp posterior area will require more time for the implant to become firm with your bone. This can be anywhere from 6 months plus.

    So in your case, either the bone graft did not induce enough quality bone to provide stability of the implant or your implant simply didn’t have enough time to integrate with your bone.

    It doesn’t hurt to seek a second opinion. It is strange hearing the treatment approach that your periodontist has undertaken. Is he or she a periodontal specialist or just general dentist?

  4. Dear Yvette:
    I am very disappointed at my collegues. We all too often comment without knowing all the details of the situation…your health history, your dental history, your habbits…etc. We assume the worst of the dentist…for shame!
    Please go back to your dentist / periodontist and ask him his feeling about your situation and ask him if he has anybody that he would like you to consult with!
    I hope all of you perfect practioners can agree on at least that!

  5. I had my implants done almost two years ago and it took six months for the screws to anchor. But my lower lip is numb and after two years it’s still numb. The implants are causing some infection and discomfort and consulted a different dentist. He contented that two of the implants are defective and I must go back to the original surgeon. He said there is no problem and the numbness comes with the territory. He wanted me to go to the dentist he recommended and have the implant crowns put in. Other dentists say they won’t comment on other’s work and will not work on other dentists work. I consulted a foreign dentist and upon examination of the xray stated that I need bone graft and that the screws used were first generation and too big causing the nerves to be pinched. Well, my dentist didn’t think so and other dentists didn’t want to comment or offer true second opinion for fear of liability.
    I’m inclined to go overseas to resolve this matter.

  6. one, bone grafts are NOT needed before all implants–this “philosohpy” is often merely revenue driven rather than clinically necessary

    two, three strikes and you’re out–dont ask the doctor more questions, find another surgeon

    three–your implant has, as SFOMS has already noted, failed and bone grafts don’t “tighten” loose (failed) implants

  7. If the implant is having problems. Removal is almost always best.

    As far as the gentleman that wants to go overseas, I suppose it would be a good write off, but there are a large number of highly qualified people in the States. Have you had a CT scan to determine the location of the nerve relative to the implants? If you have had numbness for two years, the probablity of eliminating the numbness with the implant removal is slight. As far as infection around the implants, it takes a clinical evaluation to determine the best way to resolve the problem. Are you healthy, do you smoke, how are you taking care of the implants? These all can have an impact on the outcome of the implants.

  8. Yvette, go to someone else as suggested. You have been given good advice and some good questions to ask. The implant should have been stable at the outset. Your situation seems like it is going to require alternative measures to get your implant to work.
    John, numbness does not “go along with the territory” as normal healing. please get the CT and have it read by someone that uses them routinely. Were you numb at the outset? If so, things needed attention right then in my opinion. Bill

  9. Approximately 8 months ago I had an bone graft as a prep for an implant in #7. I was told that while screwing in the implant, the bone graft split. The implant was left in and more bone material was added to the site. Is this a reasonable way to proceed, or is this a failed implant that will just be more difficult to remove?

    Thank you for any replies.

  10. This is one of several things: bad biology reladed to age, immune rxn etc., poor implant design, poor implant preperation-heat, osteotomy to large, poor quality of bone, may have to take a linger time to acitvate the implant, bone necrosis etc.

  11. I don’t know if this helps but I have recently been doing a lot of reading on the use of Forteo for a period of 8 weeks after having these kinds of procedures. There was a study done at University of Michigan if I recall and the patients that use Forteo for eight weeks after peridontal procedures grew 30% more bone than the control group. Of course, this is an off-lable use for Forteo. So you would have to pay for it. I finally got a script from my internist because my mouth has been a mess for about 5 years now since I had some extensive dental restorations and recently a bone graph due to periodontitis. I just have to get the money together to go ahead with the plan. I also am oozing fluid from a tooth below the bone graft. I think sometimes some of us have a metabolic problem with integrating bone and Forteo is looking like it might be great hope for the future for some peridontal and oral bone conditions (including osteonecrosis). (In my case I did have parathyroid adenomas and they are associated with peridontitis according to the Merck Manual.) This information was also in Arthritis Today — the part about using Forteo.
    When I get the money together I will be sending a script to Canada since Forteo is so expensive.

    Also, I have started adding protein drinks made with whey protein isolate to make sure that I get enough protein. Many times it’s easy to think you are getting enough protein, but you may not be. I have been using JayRobb Whey Protein, protein shots from Protica, and pure amino acids from Alpha nutrition in Canada. I think the pre-digested and filtered whey protein isolate make it to the necessary sites easier.

  12. I had a bone graph done 9 months ago in preparation for two implants. Went in for implants and after the dentist opened he found that there was not enough bone for the implant. Not sure if I should try the bone graph again or just forget it. I found that I have been slightly anemic and wonder if that would have any effect on the results of the bone graph. Also, I chew nicotine gum and am curious if that would cause problems? I would like to get the implants, but don’t want to go through the procedure with same results. These are upper teeth.

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