Are these dental implants salvageable?

Occlusal overload might be due to molars/premolars mastication deficiency. The lower X-ray shows a typical consequence for perio because of pulp burning or tubules not sealing after dentin preparation. The likelihood of implants failure is much more than to save them. In any case, if implants had been splinted with laterals they would’ve been more stable.

I wonder if it might be possible to use easygraft to establish a stable bone level . Peter Fairbairn will be one to help you here

I also irrigated like crazy but can still see bits of titanium from grinding on the implants. Hope that doesnt cause issues...

You need to be a little more detailed in your description of the treatment you rendered. You said you "applied a laser to the area" What kind of laser? Erbium, NDYag, diode? When treating a failing implant, don't throw the kitchen sink at it without a specific reason. Treatment can be chemical, mechanical or both. After removing the granulation tissue you need to debride, detoxify and disinfect the infected implant surface. The threads of the implants cannot be cleaned by the ultrasonic scaler. You would need to remove the surface iregularities(threads) by grinding before you can actually clean and treat the surface with ultrasonic and chemical means. In my office I use the method originally reported by Dr. Robert Miller, the YSGG laser to debride and decontaminate the infected threads without removing the threads and risking altering the environment needed for regeneration of the lost bone around the implants. The results I have gotten are encouraging, but I can only find anecdotal reports in the literature. The radiographs show that the bony walls of the defects were high interproximally, which means that there was potential for bone regeneration from cells from the adjacent bony walls. Those implants are in the esthetic zone and your intervention without attempting to graft the area will result in a major alteration to the soft tissue architecture. If the patient has a high smile line, the result will be very unaesthetic. Also if you are limited to mechanical alteration of the surface, I would suplement it with chemical treatment of the surface with tetracycline since mechanical means alone did not leave the surface smooth and clean. Tough case. Good luck!

Hi Rob , yes you could try but prior to removing the threads as has been done here although maybe1 or 2 could have been polished off and then the rest grafted with Easygraft 150 . As to cleaning , the mouth is full of bacteria hence I merely blast the surface with a prophy jet and possibly etch to try and return the surface back to its former state then garft with the Easgraft which is stable and even initially bacterio-scidal without mixing ABs in as they may pollute the surface. So the are is protect from soft tissue and granulation tissue re-ingrowth and the body does the rest with the graft material fully bio-absorbing. NO HA usage as you cannot then assess the results long term using radiographs as a "good " rad picture may just be HA in fibrous tissue! Yes we have had great results , but in the aesthetic zone there can be trouble so be careful and warn the patient. The surfaces of some Implants with bigger threads and more extreme etching may be the cause in this short space of time as well. Peter

Ahh great information so far. I didnt think about using citric acid on this since I was grinding all the threads off anyways. I used a peridex rinse to irrigate. Used a diode laser everywhere. I think grafting a site this infected was beyond my comfort level. I like to let it heal a bit first. I saw the patient today 1 week post op. Healing normally with good esthetics. But since #7,8,9,10 are all compromised, I just set the seed in his brain that in the future, whether in a year or 10 years, we may want to ext #7-10 and do #7,10 implants with a bridge and possibly #6,11 crown with good canine rise.

If not mobile, yes. Get your periolase ready and adjust occlusion.

WHY would you would want to save this implants? Loose them , do as planned and place 7/10, and graft, use a fixed temporary. Probably will need also soft tissue graft later on , and then a 4 unit bridge. You will spend countless hours and resources and will most likely get a mediocre result. If they were in your mouth what would you do?

go to Millinneum laser periolase These implants will not be mobile until the last tread is compromised LANAP is the best technique by far, I have done it all , flaps, osseous grafts, citric acid ,EDTA , emdogain Millennium web site will have examples of success, not perfect but better than all other methods!

I would love to see the lon term result from this case. The responses you have had are probably the most intelligent I have ever seen on this forum. You have two choices: reenter and graft before the tissue retrats and is lost or remove the implants, graft the sockets, then extract/implant 7 & 10. The question is what caused this to begin with? If you do not solve that then 7 & 10 will also be doomed. I have not used Easy Graft (beta tricalcium phosphate) but I have had good results with autogenous bone obtained with the MX Grafter (Salvin Dental Specialties) mixed with Pepgen-15. This requires placement of a collagen membrane (RCM-6 from Alvelogro or Ace) and membrane tacks. Good luck on your case and please re-post.

It is proven fact, that you can grow bone next to an implant, but you will never get the same degree of integration obtained at initial placement . Once you" buy into this philosophy", treatment planning takes an entirely different direction. Pocket depths can be reduced, but the implants are not going to be more stable, except from possibly an OH perspective. If you are going to attempt to " save these ", this patients needs to be on a strict recall. Bv

No wonder they aren't cleaning the area ! It's "roped off", with ortho wire. I hope this guy wasn't trying to save the implants by immobilizing them. If so, then I would suggest he look up "wolfes law". It surprises me to see so many people splint implants in these situations. Are we not trying to do away with that type of dentistry . If this patient doesn't vest him or herself more, they would better be treated, by fabricating a fixed partial from 6- 11 and calling "it" a day. Bv

sorry my english. i think this case has a bad prognosis, not only for the difficult that represents treat the macro and micro superficies and then keepit health in time but furthermore the implants had lost support almost 50% and this seems progressive (only 3 years ago!!). If the 8 and 9 was natural teeth, i would make anything to keepit into mouth, but it isn´t. Besides, that the implants are not movile is just a survival rate, not success rate. i suggest the implants extraction (you must avoid keep this vertical bone lost), regeneration technique: allograft (we use Puros) (but you only will reach new bone in remaining implants sockets), and six months after, install just one new implant in the best resultant site. two implants difficult interimplant bone tissue irrigation and you rapidly will lose the remaining papilla. Only with a good provisional tooth (and maybe with a soft tissue graft) you can achieve an acceptable result. If you want something more esthetics you must be more aggresive. Extractions of lateral incisors too and install two implants in this two sockets. this way you will have a more coronary point where the new implant plataform will be, 2 implants with 4 teeth. my modest opinion from a third-world country. good luck! Camilo