Dr. G asks:
I recently placed an implant for a mandibular first molar. Three months later, a periapical radiograph revealed crestal bone loss to up to 3 the third screw threads. The implant fixture is clinically stable and not mobile at all. The periodontal condition is stable without bleeding on probing and there is no inflammation. The gum tissue covers the implant and does not expose the threads. Other than the bone loss, the osseointegration seems to have proceeded very well . How should I proceed now? Is there anything I should do about the bone loss other than monitor it? Any problem with going ahead and restoring it with a cemented PFM?
Periapical Radiograph of Implant Reveals Crestal Bone Loss Up to 3 Threads: How To Proceed?
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Be cautious! Frequently the radiographs make us misinterpret. The post-op radiographs taken for determining “crestal bone change” should not be of high density (dark) because marginal bone is often relatively thin, or less mineralized in early phases after surgery.
If the radiograph is of low-density and you see bone loss yet, search for the cause:
1. Re-evaluate patient’s systemic condition
2. Doesn’t she/he wear removable prosthesis over implant area? Or was there any other pressure over the implant area in healing phase?
What to do:
Eliminate the suspected causal factor(s); Wait for two next months, take another high-quality radiograph:
.If bone loss is progressive yet, remove the implant. Reconstruct the area and re-install the implant 6-8 months later.
.If bone loss is stopped, open the area and cover the exposed implant with bone graft and membrane(preferably Ti-reinforced),and re-submerge the implant. Wait again for another 6 months. Evaluate it again. If the problem has been solved go on to the next step.
Hope you success,
Neda Moslemi
Re-check the occlusion
Sorry lack of corrrect reading ……doh
You have to compare both immediate post operative xray and the delayed one 3 Mo. to see if the bone loss is true or you insert the implant suprabony.
You didn’t mention if you already loaded the implant or not. Immediate loading followed with rapid crestal bone loss is usually because of improper planninig of the case.
What to do:
If you are already loded the implant remove the crown ant do another provesional restoration which is out of occlusion, then reintery for bone augmentation using bone graft and reinforced membrane.
If you did not load the implant wait for another month then do another xray to follow the progress of the resorption, if it is progressing, it is better to remove, augment and wait for 6 monthes before replantation
Believe it or not you may be OK. On most implant systems you would have the same problem after loading the implant the first year anyways. So this may not be a big deal since you would have lost that crestal bone anyways. I suspect that your healing cap/screw may have been none sterile or got contaminated. If you are sure that the implant is integrated and the bone loss is not anymore than you describe, go ahead and uncover the implant and make sure to lavage the implant core/lumen and use a sterile healing cap (antibiotics ointment or Periogard rinse. I don’t see any problems with restoring it either, but if you want to be cautious leave the healing cap on for a while (3 months) and reassess. I had similar cases in the past that got better after uncovery and have remained stable for many years (5+).
This question came up a few weeks ago and the consensus was that augmentation had little chance of success (without a magic wand). What material, without vascularity, will integrate with titanium? It may look nice on an xray. Most also agree that you often get some bone loss but it does not compromise clinical success. Good luck with that sterile oral cavity.
Evaliate the occlusion. You may be ok.
did you do impression after the implant or you do it later after 3 months ?
because sometime shit happens you know… the impression stuck between implant and crestal bone
or maybe you did that during the 3 months… like you take impression for the other side of jaw. for onlay in the other tooth…
this is just sharing experience between implantologist
i have bad experience with impression stuck in the crestal bone of implant, before it heals. and you know impression does not appear in ro foto… just maybe
check with probe and tear the gum gently so you can see what the problem really are….
You did not mention the brand of implant you placed, whether this was a two or one-stage procedure, if it was an extraction/immediate placement, or, if it was a healed site and two stage procedure, how you did the secondary uncovering. Any of these can cause crestal bone remodeling. With more information we can probably diagnose the reason for the bone loss in this case. RJM
As you know reflecting a flap for stage I implant surgery will result in compromised vascularity to the crestal bone. This might be the first reason. This remains the advantage of usiing flapless procedure.
Second maintain sterility of the cover screws.