7-Year old anterior implants: proper treatment plan?

Last Updated: May 14, 2015

Today a new patient from Peru came in for an emergency about a fractured maxillary molar, but I couldn’t resist taking a radiograph of her 7 year old anterior implants to see what was underneath. Much to my surprise was a surprise! Are the threads stripped off on the #21(9) and is it surrounded by a radiolucency? They are definitely not seated properly #11 ( 8 ) more than the #21 ( 9 ), but what kind of implants and what do people think the proper treatment plan is, if any? Patient has Zero symptoms, but is unhappy with the aesthetics, i.e. Splaying of the central incisors. The composite covering of the access hole keeps coming off for obvious reasons and she seems to be occluding on the abutment screw as well. Thoughts?

![]Analog Radiograph taken May 13th 2015](https://osseonews.nyc3.cdn.digitaloceanspaces.com/wp-content/uploads/2015/05/Anterior-analog-radiograph-May-13th-2015-e1431631283765.jpg)Analog Radiograph taken May 13th 2015
![]Frontal view of dentition](https://osseonews.nyc3.cdn.digitaloceanspaces.com/wp-content/uploads/2015/05/Frontal-View-e1431631293740.jpg)Frontal view of dentition
![]Full retracted view of Maxilla showing the fractured maxillary molar she came on to fix](https://osseonews.nyc3.cdn.digitaloceanspaces.com/wp-content/uploads/2015/05/Maxillary-Arch-e1431631302449.jpg)Full retracted view of Maxilla showing the fractured maxillary molar she came on to fix
![]Close-up of Access holes and occlusion on the screw and hole](https://osseonews.nyc3.cdn.digitaloceanspaces.com/wp-content/uploads/2015/05/Close-up-showing-occlusion-on-access-hole-e1431631312490.jpg)Close-up of Access holes and occlusion on the screw and hole

7 Comments on 7-Year old anterior implants: proper treatment plan?

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CRS

05/15/2015

To be honest, it is not that bad considering how it was restored. The implants appear to be integrated with moderate bone loss probably due to the unseated abutment and splinted crowns, I bet they were splinted to make a papilla. Since they are screw retained, remove the crowns and place provisionals, unsplinted for hygiene and to allow the midline papilla to regenerate. If the case were referred to me, I would graft the periodefects. This might be a case for full full porcelain abutments/crowns that will help the dark margins and esthetics. The implants are actually pretty good, the restoration is poor and with good lab work and a bit of grafting the outcome should be great. I would advise working with a surgeon who has experience with grafting and a prostodontist look over their shoulders and learn in this challenging case. Now the next posts that may criticize this, will find that occlusal and restorative questions can be addressed when you work with a prostodontist and have a good restorative plan. If nothing is done then these implants will be out in 2-3 years in my estimation. They got the screw retention right.

Steve

05/18/2015

CRS I agree with your opinion. Implants look fine integrated and considering the 7 years of working, the outcome may be considered as average?... It can be fixed though with a good surgeon and a good prostho design. My question to you is why do you believe that the implants will be out in 2-3 year time, if nothing else done? How can you predict this outcome? Many thanks for your input. Steve

CRS

05/18/2015

I stated if nothing is done typically we start seeing problems at 7-8 years, right now this is repairable. Since the etiology is still there the damage will continue to progress implants take 2-3 years to fail. Now you can question why I stated this or you can fix the problem by finding out the type of implant and restoring the case. If you do nothing there will be quite a bit of bone loss and damage which will be difficult to repair. The radiolucency is the variation in bone trabecular pattern and the threads are not stripped off in the lower third of the implant, it is a different design. It is also possible that an implant with stripped threads was placed in this very poor workmanship. With implants or any other type of surgery the first time in is the best possible chance for success. Now this case will be chasing a poor job with compromised results. I have seen this often in clinical practice seems to be the pattern. If you want more info check out the AAID archives there was an entire meeting on implants failures a few years ago. Hope this helps.

Cliff Leachman

05/15/2015

What about the threads near the apex, have they disappeared or is it the type of implant?

varun dahiya

05/18/2015

To know more about composite fillings coming out I guess occlusion is the key here. apical threads are missing because of implants design .Grafting can be done here with a collagen GTR membrane to increase the life of implants. 7 years is a good time for followups and bone loss is not very severe.Proper occlusion and good perio and prostho are definitely needed for long survival in this case.

MMontana

05/19/2015

Implants look a lot like old 3i Osseotite external hex; this implant had a large cut-away in the apical 1/2 that when viewed at a certain rotation, appeared the threads were missing. Etiology for the bone loss is not so simple to explain without comparative, historic radiographs. If it occurred early and the level maintained, then it is likely due to thinning the bone at placement. If progressing through the years then it is disease and the prognosis is downgraded without intervention. Lastly, if it is a 3i from the vintage I mentioned, these implants have a nasty history of early bone loss followed by years of stabilization. The clue is to look for the presence of inflammation.

Pisit

06/10/2015

11 abutment not seated. Screw out new abt for proper gh.x-ray check for abt seat well. New 2 crown.

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