Crestal bone loss after immediate implant placement: recommendations?

We did an extraction and immediate placement of an implant in 36 site.  3 months later at second stage surgery the radiograph showed crestal bone loss.  We did not note any mobility.  We placed a healing abutment.  What might the explanation be for the bone loss?  What do you recommend for a treatment plan?

7 thoughts on: Crestal bone loss after immediate implant placement: recommendations?

  1. greg steiner says:

    This looks like the coronal portion of the bone graft failed to mineralize and the graft was exfoliated. So it is bone graft failure rather than a pathologic process of bone loss. Because the implant surface was not chronically infected this should be easy to correct with cleaning the implant surface and regrafting.

  2. GYzag says:

    Very challenging to help you without clinical photos and pre and post scans but more than likely when you placed and grafted the implant, you lost most of your graft material. Key here is use a shorter implant, sink it deeper incase things like this can happen. Did you get an ISQ preop? An ISQ in this case will objectively tell you if your implant is failing.

  3. Fotis Roilos M.Sc.Impl.,M.Sc.Perio. says:

    Looks like it was not placed deep enough originally… So you lost arround 1.5-2mm of bone circumferentially. Bone grafting in this situation will not help… If there is enough keratinized soft tissue coverage arround the implant just restore it as is… If not free gingival graft… And the most important is to monitor the situation because since there is not a polished collar exposed to the soft tissue but rough surface you may develop periimplant mucositis which may develop to Periimplantitis!

  4. Zein Adham says:

    Hi there wish you all a happy new year,

    Bone is reactive to stresses as you know .. it needs to be loaded reasonably for remodeling to happen.. that is if overload or no/almost null load occured resorption happens.. for this reason specialists have shouted for the immediate loading and progressive loading .. however nothing is certain regarding this point as we still do not know the threshold between good and bad load stresses and how we control them in pt. Mouth .. there are however signs can comfort the doctor after he has installed the implant .. check if either was affected..
    Final torque..
    Buccal plate thickness..
    Jump up gap..
    Medical status of pt..
    Duration of procedure and type of graft..
    Pt compliance and use of other prosthesis..

    Thx for sharing and good luck..

  5. Mark Bishara says:

    Immediate implants in molar sites need to be placed deeper . This implant needed to be 2-3mm deeper to respect biology and expected resorption .

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