4-month Post Implant: incomplete bone growth?

Based upon your report and a single film, it appears the implant has failed. If your dentist recommended to wait two more months it would appear to be stalling. I would suggest you get a second opinion from a local oral surgeon or periodontist with more implant experience to confirm the prognosis.

I would recommend getting a Dental Cone Beam CT scan to get more information before jumping to conclusions.

Anon, In my multiple decades of placing and restoring thousands of implants, I’ve seen plenty of OMFS and Periodontists do absolutely horrible implant surgery, largely because they aren’t focused on implants and haven’t studied or witnessed enough about implant prosthetics and maintenance. Also plenty of GPs. And also have seen plenty of GPs that are the best of the best, particularly the ones who focus only on implants. I agree with your remarks about the status of the case presented here.

When you extract and you want put the implant at the same time and your situation have infection your failure rate is increase so either you should wait at least 6 weeks and then put implant or you need good cleaning and drilling and you should go at least 2mm more than your implant length and you should reach sound socket wall...no you should not wait more if by 4 month not integrated it is no need wait more you shoud test your implant either integrated or not..if not it should be removed and wait for second time....

The above suggestions are reasonable. Please understand that an accurate diagnosis cannot be given in this forum. Clinicians need more than just a radiograph to understand what is going on. So really all we can do is give you a best guess. That being said, it would seem that the previous history of the bone in the area of your implant involved infection. So there may be a “carry over” of that infection which might cause a problem. It also seems like the implant was placed immediately after extraction and this can increase the failure rate (especially post infection). However, the radiograph you provided does not give sufficient clarity to allow a precise comment to be made – hence the previous writers’ comments about getting more radiographic information (or better contrast at least). The description you gave about a spontaneously bursting pimple casts some doubt on the success of the implant and is an indication that infection may be present. Nevertheless, as best I can make out from the radiograph you provided, there seems to be bone around the implant (which is a good sign) but it is difficult to determine if integration has occurred. This process can happen in 3-4 months in the maxilla, but 4-6 months is not unheard of. So there is hope yet! With all this said, I would advise that you put your trust in your existing dentist and see what happens. If you are really concerned, then politely ask him to refer you to another clinician for a second opinion. There is an acknowledged failure rate of implants of around 5% (or more depending on circumstances eg – infection, immediate placement, immediate loading, periodontal disease) so you might just be one of the failures. However the good news is that removing an implant and allowing healing and then placing a new implant can be very successful. I hope this explanation helps, and realise that all is not lost. Have faith in your dentist, but a second opinion is always a reasonable option. At some stage your dentist will “test” the implant (there are several possible tests) to see if integration has occurred. Only then will the results be known.

The pimple was infection and it still remains because the rough implant now has bacteria growing in it where your body's natural defense can't stop it. You can mess around with it a long time and take all the x-rays recommended yet you will still have a failure.

I agree with everything Dr. Gerke said here. Very nicely worded and sound advice!

I've placed 7000 implants. Half were placed at the time of extraction. There is nothing inherently wrong with that technique. No one on this forum can state a 100% success rate. The national average is a 4% failure rate. Unfortunately failures do happen. Luckily they are generally easy to remedy. Dr. Gerke's comments are spot on. Have the dentist do a torque test or RFA test (ask your dentist). If its a fail get it out, graft the site, and do it over in a few months. Good luck. BTW Vitamin C and D have been shown to help with implant healing.

The implant has failed....it happens. Remove it, graft the site and let it heal then replace. It is a waste of time to wait. Guaranteed the implant will reverse right out. Anyone that states they have never had a failure probably has not done many implants. Neil Zachs Periodontist, Scottsdale AZ