Failing Implant #14: Thoughts on Treatment Plans?

I have a 66 year old male patient who had a crestal sinus bone graft and implant placed in #14 site about 5 years ago by another dentist.  The patient does not have any symptoms, but the radiographic images show implant failure.  The dentist asked me to remove the implant and place a bone graft.  The dentist plans to restore this with implants in #13 and 14 sites.  If I trephine out the implant it will leave very little bone on the buccal and palatal aspects.  This will also likely cause an oroantral communication.  What do you think about raising a buccal flap, removing the implant through a controlled buccal approach, doing a simultaneous sinus lift and bone graft and reconstructing the buccal wall removed with a membrane?  A periodontist suggested removing the crown, debriding the bone and placing a graft around the implant and burying the implant with the objective of regenerating the bone around the implant.  What are your recommendations?



14 thoughts on “Failing Implant #14: Thoughts on Treatment Plans?

  1. Dr. Randy Comeaux says:

    If the implant isn’t mobile, by all means have implant repair surgery done. The most predictable method is to remove the crown/abutment and replace with a cover screw so that the implant can be “put to sleep” for 4 months. You can still get good results if the crown isn’t removed. But, what caused the breakdown? You have to identify that so that it can be eliminated. The most common cause is subgingival cement, but this one may be a screw retained restoration. The second most common cause is failure to remove plaque, and plaque removal can be compromised by the emergence profile and height of contour and also by simple non-compliance. I would not remove the implant. It is easier to repair/stabilize this implant than to remove it. Do yourself and the patient a favor and repair it.

    (0)
  2. Dok says:

    Keep it, and let the periodontist do his thing ……put it to sleep. Implant in the 13 position would give this patient better function than he has had with 14 in function behind the space. No bruxism, light occlusal force, and cleansability would be a must for 13.

    (0)
  3. Beth Berson says:

    I’ve had great succes removing implants with the neo biotech fixture removal kit. Very conservative and no need to trephine

    (0)
  4. David Guzman says:

    I’ll will go with the removal of the crown and graft after the preparation the implants treats with diode laser or any other instrument that you may have and use the protocol with CITRIC ACID. After this, biomatirial of your election and pericardio membrana fix with the screw tap and also on the buccal with some tap. In my expirience i like to use creos of Nobel Biocare. Success rate on primary clousure will be higher than 80%.
    Good luck

    (0)
  5. Dr. Toy says:

    It’s hard to tell how much bone loss there is around the implant, maybe just down to the threads? I think if it’s not mobile it’s worth a shot to repair it. I would remove the crown, raise a flap to disinfect around any exposed implant surfaces and bone graft. As others mentioned, place a cover screw and let it heal. I would probably lean towards waiting 5-6 months. I’m wondering if traumatic occlusion isn’t a factor in the bone loss here. You have a lone molar with no adjacent teeth to support it doing a lot of work for that side. If the pt is a grinder that poor implant is getting beat up. Get another implant in there to share to load.

    (0)
  6. Abdullah says:

    I agree with you very much. It is not advisable for Tooth #14 to bear such a heavy occlusal load. It looks like you could easily have an implant placed in the area of #13 due to sufficient bone quantity and appropriate distance from the maxillary sinus.

    (0)
  7. Dr. J Terry Alford says:

    If you really want to do it the right way then do not remove the implant. However, removing the crown and abutment would most likely give you the best access to the implant body and the diseases bone. Once you have removed the abutment then utilize Erbium based Laser technology to reconditiion the surface of the implant. There is not other laser system that can do this effectively. Clean up the bone and decorticate. If you have the equipment then utilize PRF (Platelet Rich Fibrin Matrix)) mixed with bone particulate to graft the area. You could also use Sponge bone ( Dr. Sam Lee- Look him up on You-tube) very effectively here. If you can’t get primary closure then use a Collagen Membrane or Pericardium to close. You could probably drop in number 13 at same time and then evaluate the site in 3 months. If the site is good to go then I would wait another 2-3 months to make sure the area is stable from an osteointegration standpoint. The restore.

    (0)
  8. Sean says:

    Request interpretation of the x-rays.

    I get the impression that this implant is tissue level, but placed bone level/subcrestal. And lower left xray apart, looks like all the big threads are in bone.

    Or is it bone level fixture, with microthreads occlusally and macro threads apically? And no bone at microthreads, bone at macrothreads?

    (0)
  9. Dr Manjunath P N says:

    Even though it is clear that there is bone loss in this conventional radiograph, better to have a CBCT evaluation.
    If we divide the length of the implant into three 3rds, if the bone loss is not beyond coronal 1/3rd of the implant length & if the implant is immobile regeneration should be thought of as the 1st line of management.

    (0)
  10. Matt Helm DDS says:

    The original dentist now claims he plans to restore with implants in #13 and 14 sites? The first question that comes to mind is why didn’t he do that — place a #13 also — to begin with? That was very poor treatment planning on is part and it set this implant up for a failure from the start, because it’s being asked to bear much more than it’s normal share of load. The reasons for its failure can be multiple, as the others have already stated. But the fact that the implant is not mobile and is asymptomatic, AND the greater bone loss on the mesial point to traumatic occlusion and possible bruxing, more than anything else. It may also be indicative of traumatic food impaction caused by the edentulous space in #13 site. You’re not there to do the bidding of another dentist who tx-planned this poorly from the start. You’re there to look out for the patient’s best interests.
    As such, I am in the camp of your periodontist, i.e.: remove the crown and abutment, clean up and graft, AND place an implant in the #13 site at the same time. Completely bury both implants and don’t touch them for 6 months. You’ll be glad you did.

    (0)

Leave a Comment:

Comment Guidelines: By posting comments you agree to accept our Terms of Use, Disclaimer and Privacy Policy. For more details, read our comment guidelines. Though we require an email to comment, we will NEVER publish your email.
Required fields are marked *

Posted in Clinical Cases, Surgical.
Bookmark Failing Implant #14: Thoughts on Treatment Plans?

Videos to Watch:

Sinus Lift Crestal Approach using Hydraulic Pressure

This video demonstrates the crestal approach for sinus lift, following extensive maxillary sinus pneumatization after[...]

1 Comment

Watch Now!
GBR in Labial Plate Bone Fracture

This video case shows guided bone regeneration in a patient who presented with root and[...]

1 Comment

Watch Now!
Ridge Split Technique using Vestibular Incision Approach

The alveolar ridge split technique is a predictable and reliable procedure, though case selection is[...]

3 Comments

Watch Now!
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!