Bone has Resorbed on the Buccal Cortical Plate: What Should I Do Now?

Dr. B. asks:
I placed a Lifecore implant fixture in the mandibular symphysis site to replace a mandibular central incisor. The implant platform was 4mm submerged below the alveolar crest bone level. After 1 year, the bone has resorbed on the buccal cortical plate and there is only a thin gingival layer of tissue over the labial aspect of the implant fixture. If you look closely you can actually see the outline of the implant fixture through the soft tissue. As of yet, there is no further gingival recession and a dehiscence has not formed. What should I do now? Would I be able to bone graft this defect?



9 thoughts on “Bone has Resorbed on the Buccal Cortical Plate: What Should I Do Now?

  1. David Levitt says:

    Yes this defect can be grafted. If you have never done this before I suggest you refer to someone who has a great deal of experience as there is a great risk of making matters worse.

    (0)
  2. sb oral surgeon says:

    why 4mm below alveolar crest?? this is a clear violation of biologic width principals. you set up a zone of inflamation and lost bone. I think that even if you are lucky enough to cover this type of peri-implantitis defect with a graft, it will happen again. refer this out. get a fresh perspective. sounds like there are soft tissue issues here as well.
    removing the fixture and starting over again with better biologic principals may be a better alternative.

    (0)
  3. Carlos Boudet, DDS says:

    It is unclear whether you mean that the implant platform was 4mm or that the implant was submeged 4 mm below the crest.
    Both are unacceptable.
    The bone dieback to the implant platform will create a problem.
    You may be able to graft bone buccal to the implant, but if the soft tissue biotype is thin, you will still see the abutment through the tissue.

    (0)
  4. Jeevan Aiyappa says:

    Dear Dr B,
    I guess there is a need to have some more details regarding the situation and its background.
    – How old is the patient?
    – Why did the pt lose only the incisor ?
    – Was it lost due to periodontitis or was their a history of trauma and consequent loss of tooth?
    – What is the nature of the occlusion in the anterior region? Is there a traumatic bite ?

    Going back to the time you placed the implant –
    if you had to submerge the implant by 4mm (usually not necessary even in immediate extraction implants, except in the esthetic zone, where it is placed around 1.5 to 3mm below the alveolar crest / adjacent gingival zenith as is appropriate) , below the crest, is it likely that the labial plate (alveolar) was thinned out considerably at the time. Was it the reason that prompted you to place the implant that far apical to the crest ?
    If the labial alveolar bone was so deficient around the central incisor, it is highly likely that the bone around the adjacent teeth in the vicinity (the other incisors) was also affected significantly.
    If the adjacent teeth had periodontitis at the time, it is not unexpected that the peri-implant bone has resorbed after implant placement from the periodontal disease and inflammation pre-exisitng in the immediate vicinity.
    Trying to graft the Labial bone deficit without assessing what caused it, would tantamount to “Filling a Leaking Tank”…

    Would be wise to recall an old saying –
    “An empty tank does not leak ;
    while a leaking tank never fills!”

    Cheers
    Jeevan

    (0)
  5. Paul says:

    “removing the fixture and starting over again with better biologic principals may be a better alternative.”

    YUP

    (0)
  6. Emrah Vaziri says:

    Dr.B March,22.2010
    Thanks Dr.Sb
    Undercut on labial sourface below the crest of the mandible is very obviously.
    1-Submerged 4 mim implant mean you lost cortical bone( which part of the bone is very dense, wide and impacted).
    2-Luck of the circulation in bone by implants especially in this case face to the thin bone was a reason on buccal cortical plate bone lost.
    3-Thin gingival layer helped to resorbed bone easier and reslt of bone lost.
    4-Place implant to labially.
    Dr.A. VAZIRI

    (0)

Comments are closed.

Posted in Clinical Questions, Dental Implant Complications.
Bookmark Bone has Resorbed on the Buccal Cortical Plate: What Should I Do Now?

Videos to Watch:

Lateral Sinus Lift: Perforation, Repair, and Implants

These two videos demonstrate the lateral window sinus technique, and implant placement following the repair[...]

Watch Now!
Single Tooth Replacement with Implants in the Esthetic Zone

Dr. Jack Hahn provides tips and reviews cases for implant placement in the esthetic zone.[...]

Watch Now!
Surgical Consideration for the Flapless Approach

In this video, Dr. Jack Hahn discusses and presents cases to review the surgical considerations[...]

Watch Now!
Bond Apatite: Socket Preservation Cases

These 2 videos show the use of Bond Apatite in socket preservation cases, one with[...]

Watch Now!
3D Guided Implant Placement

The placement of multiple implants in this case was helped thru the use of 3d[...]

Watch Now!
Ridge Splitting Cases in Narrow Alveolar ridge

This videos shows ridge splitting, which when combined with bone expansion, is an effective technique[...]

Watch Now!
Placement of 4 Implants and Cement-Retained Bridge

The treatment plan was to extract the lower incisors, canines, and lower premolar and place[...]

Watch Now!
Failing Bridge Replaced with Dental Implant Supported Bridge

Ahe patient presented with a failed dental bridge from the upper right canine to the[...]

Watch Now!
Lateral Sinus Augmentation with CGF

Following membrane elevation with the lateral approach, and confirmation of an intact sinus membrane, concentrated[...]

Watch Now!
Titanium Mesh for Ridge Augmentation

The use of titanium mesh is a reliable method for ridge augmentation to provide adequate[...]

2 Comments

Watch Now!
Implant Grafting Techniques: Demineralized Sponge Strip and Tunneling

This video reviews several unique grafting and surgical techniques, including the use of demineralized cancellous[...]

Watch Now!
Mandibular Fixed Screw Retained Restoration

This video shows the use of a surgical guide for a mandibular fixed screw retained[...]

1 Comment

Watch Now!