Can I stop the bone loss?

I installed the implant in the mandibular first molar site and restored it with a cement retained crown 2 years ago.  The patient does not have diabetes, does not smoke and has good oral hygiene.  The implant has considerable circumferential bone loss and is slightly mobile.  The crown is still firmly cemented.  The patient is chewing comfortably on the crown.  What can I do to prevent further bone loss?   Is there any way to regain the lost bone?  What are your recommendations?

12 thoughts on “Can I stop the bone loss?

  1. rsdds says:

    from what I can see the bone remodeling is normal but i would be concerned with a small diameter implant taking up to 800 psi under function

  2. Dave says:

    A functional implant should not be “slightly mobile”. This is a much bigger concern than the crestal bone loss. I would focus on this issue first.

  3. Peter Fairbairn says:

    Mobility is an issue….. but as for bone loss …… may stay the same , may lose more , may regain some never sure ……
    Peter

  4. DrT says:

    Just try to be certain the mobility is the fixture and not the crown. If it is the fixture, then it is best to remove now and preserve bone for another fixture.

  5. greg steiner says:

    The implant is not mobile it is the restoration. If the implant was mobile it will show on the radiographs and the patient would not be able to chew on it without pain. The implant is not wide enough to handle the load. If the narrow implant was placed due to deficient ridge width then ridge augmentation should have been done to facilitate an adequate size implant. In order to provide opinion on the bone loss we would need to know what type of bone we are looking at. Was it grafted and if so with what material. Greg Steiner Steiner Biotechnology

  6. Joseph DeLapa, DDS says:

    I would try to drill through the crown to access the screw and unscrew the crown and abutment from the implant so that you can evaluate the implant. It is possible that the screw is loose due to the mesial cantilever affect of the crown which can cause the screw to elongate and stretch enough to become loose. Whatever it is you need to get that crown off first.

  7. Kwan Lee says:

    mobile ?

    implant or crown?

    looks like abutment is loose.

    drill the hole and retighten the restoration.

    bone loss due to loose restoration.

  8. mpedds says:

    Looks like the crown margin is sub-gingival. Almost impossible to clean cement thoroughly in a situation like this. Retained cement has been shown to be a major factor in bone loss around implants and it is seldom visible on a film. Remove the restoration and check for cement. Really no reason to have the crown/abutment margin so deep on a posterior tooth in a non esthetic region. If you re-make this, place the margin at or even above the tissue.

    • Dr.T says:

      I agree with this 100%. You may have lost bone due to cement. If so, then it could certainly stabilize once the loss is below the irritating cement. Any BOP? Suppuration? Probe depths?

      Drill through the crown to retrieve the screw, unscrew the abut, check the implant stability by attaching an impression coping and trying to move it, if the implant is integrated (which I agree with Dr. Steiner that it is), then re-impress for a screw retained crown and torque it down per protocol, then use shim stock to take this new crown ever so slightly out of occlusion. You should be fine after that.

      Post a follow up afterwards so we know the outcome! Thanks! And Good Luck!!!

  9. prz says:

    thank you all, for very useful suggestions, my plan is to remove the crown and check the abutment screw,and implant.,i will post when i when i finish

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