Implant-Supported Bridge with Bone Loss: How would you treat this?

A new patient presented to my office with broken #3. She is 68 years old, healthy and has no active periodontal disease, even though bone loss is evident on the x-rays. She reported that the implant bridge was done about 1-2 years ago. My question relates to treating the bone loss on the implant supported bridge. The existing prosthesis has been designed poorly and has large overhangs on all abutments and pontic. What options do I have for treating the bone loss around the implants, especially #31, after removal of the existing 3-unit bridge?

13 thoughts on “Implant-Supported Bridge with Bone Loss: How would you treat this?

  1. Ed Dergosits says:

    I do not think you will be able to gain any vertical bone height with any procedure. The overhangs are likely resin cement. I would use a flame shaped finishing burr to remove the cement. I would also consider endodontic treatment of #3 and restoration with a crown.

  2. mpedds says:

    These look like Nobel Active fixtures. Look closely at the collar. See the micro threads? These should be buried in the bone i.e. these are meant to be bone level fixtures. When they are exposed like this they are doomed to failure.

    • Oleg Amayev says:

      This is not a Nobel. Nobel has conical connection. These looks like some type of Israel made implants AB or MIS, or other. They all have this type of connection like Zimmer.
      AB or MIS are good Implants they been since 1995 I think and very popular.

  3. DR KG says:

    If there is no sign s of periimplantitis, IMHO no treatment necessary, just review in 6 monthly intervals. If the 47 implant fails due to physiological bone resorption, then redo treatment. Excess cement must be verified clinically. The overhangs might not be overhangs. They might be modeled porcelain on buccal side.

  4. Dennis Flanagan DDS MSc says:

    First get the immediate postop film and compare it to this film. Do not remove the bridge at this point. The peri-implantitis, if that is what it is, can be treated non-surgically with bleach, peroxide and Arestin weekly for 3 weeks with probable resolution. #3 needs treatment above all of this. Don’t get yourself in trouble over the bridge.

    • Yaron Miller says:

      Thats exactly what I did and I’m waiting for the other office to email the x-rays. What would be the disadvantage of removing the bridge as this would allow better access for cleaning the implants. Anyway, the existing bridge cannot be left as is, since it is a really bad food trap and the patient cannot clean under it.

  5. Dr Emil Svoboda PhD, DDS says:

    If you are already planning to change the bridge anyway, it would be good to remove it by accessing and removing the abutment screws. The implants look rather parallel in this view, and that should not be too hard to do. It would be good to identify whether there is residual subgingival cement or not. The prognosis or retreatment would be better if you could identify the likely cause of the problem, cement or occlusion or something more sinister. Then I would raise a flap, assess the damage and then decide to graft or explant the posterior implant. Next time use an intra-oral cementation process that controls excess cement. Go to http://www.ReverseMargin.com for more information.

  6. Dr. Omar Olalde says:

    Good case!!
    These implants are bone level, and they were not placed at bone level, they are higher. Because of the roughness and porosity of the surface they are retaning plaque and that´s why the loss of the bone.
    We don’t know if any implant is lost because they are ferulized with the bridge.
    I would take out the bridge, cutting it. Diagnose the stability of each implant and the deepth of the pocket. If everything is OK, then reshape with burs each implant, polish the surface and do an hygienic bridge.

  7. Gregory Steiner says:

    Find out the history of the site. It appears to be grafted with cadaver bone due to the sclerosis. If the site was grafted with cadaver bone the bone is failing and it is not infection. It will not respond to regeneration. If the site was grafted with cadaver bone you will need to remove the implant and all of the sclerotic bone around the implant until you reach normal bleeding and then graft with a bio-compatible bone graft.

  8. Adibo says:

    The implants are too superficial. I am not sure if you can change the course of destiny for the implants. Check the baseline radiographs and don’t touch the bridge otherwise it will be asking for trouble and ending up in disaster both for the patient and youself.
    Although the bridge is badly designed, there are, as I have understood, no symptoms and no clinical signs of infection. Clearly no reason for removing the bridge. The damage has already been done by badly placed implants and you can not improve the bone around the implants.
    With regards to suggested grafting by some of the colleagues, there is no indication for it and the site is not favourable for any grafting anyway. You can’t graft around 1/3 of the implants that sticking above the marginal bone. You need at least one bony wall for grafting.
    Finally, let’s not forget the age of the patient and life expectancy of the implants and the bridge that may exceed the patient’s!
    I would monitor the bridge every 6-12 months and focus on the upper right molar instead.

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