Extraction of 15, 16 was done in August 2020 with bone graft. In January 2021 14, 15, 19 implants were placed. 14, 15 were uncovered in June 2021, 19 was not covered by the gum. All implants were restored in September, October 2021.
There is a significant bone loss compare between June and October X-rays. There is a 5mm pocket and bleeding on probing. What could be a reason of the bone loss? Can it be fixed?
Thank you.
Brad McLaughlin comments:
Make sure occlusion isn't very heavy and there is no parafunction in lateral movements.David Levitt comments:
Judging from these films there does not appear to be any problem with the lower implant. Also, it appears a sinus graft was done on the upper and done well. The problem appears to be bone loss on the upper only. I have performed at least 7,000 implants and get referrals like this on a regular basis. I would expose the implants, clean the surface with citric acid, remove any exposed threads and then preform an apically repositioned flap to make them more cleansable. They are very salvageable. Of course as mentioned previously you have to make sure the occlusion is not a problem. All of the comments regarding xrays that are accurate are on point but the bone loss is definitely there. Making them cleansable is the most important factor. With implants that close together and at that angle to each other that requires a re-entry surgery and modification of the implant surface. increased flossing with chlorhexidine is a good idea but I doubt it will solve the problem permanently. A good periodontist or very well trained surgeon can do this procedure for you.Anonymous Anonymous comments:
Thank you for your reply. Is it possible to graft the bone back? e.g. I read about the reconstructive graft surgery.Charles Brent Geffen comments:
Living tissue will always change while materials will not ( unless wear and tear and fractures etc). You may stabilize and follow-ups with your existing surgeon will direct / advise you what the correct course of action will be. I prefer to advise minimum invasive preventive treatment to avoid new reactions to man-made tissue replacement. If treatment now will prevent more complicated treatment later then sure, if it makes logical sense treat. If not follow up six - twelve monthly and react when the indications present. I think it’s early days and everyone needs to “chill” and avoid over treatment (for now). Please let us know progressCharles Brent Geffen comments:
Probably occlusal stress 2nd 3rd Q : would be interested to follow comments once details posted ( habits, age, 1st -4th Q function, reason for loss ?? ) Pre placement info too lacking to comment further) Graft details ?Brian comments:
Woah. That’s a hair of bone between the maxillary implants. If the angle is correct. Occlusion probably but those 2 on top must be a nightmare to get an as the tic resultNeil Bryson comments:
The upper X-rays were taken at different angles which makes it difficult to compare. There was very possibly less bone on the pre-restorative than it shows in picture. A 3D scan or at the very least a pano shot from the same machine pre-op and post op is vital here. Also, there could be a problem with placing the lower implant too far below bone level and good biologic width being violated but again, these pictures are not conclusive. Type of graft, density of bone at implant placement, and amount of torque that surgeon was able to obtain on these implants would be useful info. Certainly, you need help from a dentist or periodontist who is familiar with treating failing implants. These could be salvageable if attended quicklyMark Bourcier DMD comments:
No one can look at these or any x-rays and tell you why you have suffered bone loss - at best we have educated speculation. There is nothing inherently wrong with the implant placement. Any advice you get has to be taken with a grain of salt because this can happen to anyone and we all have our biases as to what may cause bone loss, though everyone has the best of intentions. I will share my biased opinion with you. I don't think it is due to occlusion (how the teeth hit the opposing teeth.) This does not come into play unless the teeth are put into function before they are osseointegrated. If I had to speculate why the bone has gone away, I would say your bone graft did not produce vital bone that it capable of remodeling in response to forces placed on it, and that, I believe, is true of most allografts (dead person bone) and xenografts (dead animals bone.) But this is controversial to say the least. If we had a consensus on how to avoid this I don't think it would be happening.Frank Lackee, D.D.S. comments:
Love this answer Mark. So on point!!Greg Kammeyer, DDS, MS comments:
So they've covered some of the issues: Other questions I routinely as ALL patients: are you diabetic? IF so what was your last A1C? have you taken SSRI antidepressants? have you taken bisphosphante (bone sparing drugs-pills or worse yet shots, for osteoporosis or some forms of cancer)? Have you taken Proton Pump Inhibitors ? (for GERD), How high is your cholesterol? Have you had your Vit D3 level checked. Do you exercise? How much alcohol do you drink? do you consume recreational drugs? Did the dentist build the buccal bone to 2 mm thick? Did the dentist make sure there is attached tissue that is 2mm thick? These last 2 plus Vit D are key causes of problems. There is alot to implant stability...Not to mention that modern implants have 10-12 metals in them including Nickel and Iron. You could be having a reaction to one of them....esp since the post in the implant isn't the exact same metal as the implant itself.Guest comments:
The Upper implants are too close together and angled poorly. It looks like the bone loss pattern is due to inability to keep the area clean. The lower implant is too far away from the other tooth so you have a bulky crown you can’t keep clean. The bone loss is consistent in areas you can’t maintain hygiene. Was a guide used during placement? I’d advise seeing a prosthodontist to see if the implant crowns could be remade so that you could keep them clean, otherwise with this rate of bone loss they will fail. You have early peri implantitis.Richard Benian comments:
I would remove the implants before more bone is lost. Graft and cover with membrane of your choice. Get CBCT and make surgical guide. Use guide to place implants. If you try to screw around gum gardening them you will PROBABLY never regenerate the bone height and always have deep pocketing around the implants that you will never be able to to keep clean. I think maxillary implants are to close to each other also. All three are not in best positions. WHEN IN DOUBT TAKE THEM OUT.Dr J B comments:
I think the xrays are deceiving. If you look at the distance from the implant apex to sinus floor you will see a huge difference between the July and September xrays. I suspect the bone loss preceded July. The Sept is overangulated. Or the July's angulation just makes it look better than it is.Anonymous Anonymous comments:
I see. The doctor informed me that he would like to replace the angulated implant with a new one, a bone graft and possible replacement of another implant as well.