Cyst and bone loss: any suggestions?

Clearly an issue that needs to be dealt with , if you restore and they fail you will be responsible . It needs surgical intervention and he is best placed for the treatment . I will post a case with treatment of "retrograde prei-implantitis " using synthetic materials .... Have you shown the scan to him ? Peter

Yes. I sent him the same screenshots of the scan. He now agrees that maybe he should open it up and clean it out. The same for the cyst in the anterior.

Great , insist on it as your patient deserves a solution , things happen and we need to sort it out . Not sure why so many Implants close together ( may be x-ray angle ) ........ but not a GDP so maybe not restoratively aware. Good Luck

There was no practical need for the CBCT images to cover such a large area (the whole skull). If it had been focused on the area of interest (upper jaw slices) only, the quality of the images would have been better.

Sounds like you initially only sent the report not the CBCT, with pathology this large was there not any alveolar expansion or mobility of the implants?What was the timeframe between placement and presentation to your office? This did not happen overnight. Looks like a pathologic lesion which needs to be removed and sent for diagnosis. I would remove, remove the affected implants since it would be difficult to remove pathology from the implant surface and graft. You could also stage and remove the implants once you have a diagnosis. Does not look like a typical retrograde peri implantitis but an expansile lesion with a lining. Would love to see a preop pre placement film of the area.

These are ASTRA implants. While not what we want to do they are amazing at being stable where other implants would fail. I have a patient in my practice with an 8 mm few thick threads exposed on the buccal of #31 and it has been stable for 15 years. We all want perfect results for our patients and long-term pretty pictures and radiographs, but sometimes less than optimal conditions can be stable. It can be hard to convince patients to treat implant disease unless they are hurting or falling out. Warnings of further bone loss go in one ear and out the other. I agree with all of the above that the ideal would entail removal enucleation, bone graft etc. - no one can argue with that. I am simply trying to suggest that if the patient doesn't perceive a problem and another doctor doesn't either, then we have to walk gingerly around these situations. Certainly don't get involved but it may not be worth it to go too far into a hornets nest. State your opinion and let it go at that.

Hi, What is this down there? Amalgam? Some other metals? Try to think about galvanisam.

Looks like a Nasopalatine cyst in the anterior. The sequence of radiographs is not clear in regards to dates taken. #15 implant looks like it has lost more than 50% of the bone. The implants around the nasopalatine cyst and 15 may need to be removed, the cyst removed and a path report obtained. More information regarding this case would be valuable. Please show the outcome of this strange case. Thanks for sharing.

in fact, this is a medium/ large cyst and needs immediate removal. the implants (moving or not) are not more important than the maxilla health state. i would argue that not intervening is a malpraxis case.