Need for Implant after Extraction and Prognosis for Existing Implant?

Assuming you have no medical contraindications for the implant surgery, you could have the implant placed today if you wanted. There may be a buccal dehiscence in the alveolar bone. The site should have been grafted, and the implant could have been placed sooner to try to maintain the greatest bone volume for the implant. The Nobel implant may not "appear to be infected" but the bone loss exposing the threads means that it is. It needs to be decontaminated and grafted. Good luck!

Dr Boudet is right. The bone density and volume may be lacking as it appears there was no socket preservation procedure done. I am more concerned about your existing implant. The vertical "V" shaped defects indicate that their is too much pressure on that implant. It looks like you are missing both molars which are designed to take the most force. It makes me wonder if you clench or grind your teeth at night or during the day? If I was seeing you, based on too little information, I would strongly recommend exploring the cause of those defects.....they will lead to implant failure.

The implant that is replacing molar tooth is failing, and removing it would be a good option as the bone behind it is not healed, and there is a remnant of the extracted tooth present. The extraction site of the bicuspid is not healed, and must be scraped to remove a piece of the root canal seal from the extracted tooth....and the site grafted.

Appreciate your comments greatly. Can you recommend someone in Vancouver BC Canada? I am considering an oral surgeon who does implants but doesn't place crowns. It is difficult to choose since dentists approached Just want to place a quick implant with no regard for existing obvious issues.

When was the existing Nobel implant placed? Was this an immediate implant?

If you find a good oral surgeon, they will know what to do. I expect they will want to remove the old implant. Whether they want to clean the sites and graft – then implant after 3 months or whether they would clean the site, implant and then graft at the same time would be a clinical decision by them and probably orientated around their own experience and what implants and graft materials they use. It would be for you both to decide whether this was done under general or local anaesthetic. I would suggest that you ask the oral surgeon who is a good dentist to place the abutments and crowns. The surgeon will work with a number of dentists and the surgeon will know the quality of dentists’ work and can advise you – perhaps with geographic location influencing your options. Alternatively you can search out a periodontist who places implants. Placing the implants does not look very difficult so that option should be fine. The real issue is to avoid the nerve running somewhere under the implant and you will need a special 3D Xray to distinguish it before surgery. To select either type of specialist, you could do a Google search or ring the local dental association office and request advice. The tests for you to apply at the initial consult (to select who does the work) are as described above. Will they sort out why there is bone loss around the implant, will they clean the sites properly and remove any residual infection, will they graft, will they use an internal fixture implant rather than external fixture? If they satisfy you in these areas then they will be fine.

As a practicing General dentist in British Columbia for over 30 years I can state that we have all been influenced by the career of Ken Lee. However, I also am uncertain about his current availability to new patients. A significant influence in my area of Kelowna has been Dr Ickert who runs a teaching facilty as well as a private practice in Langley. Well worth the drive to be able to see a true craftsmen.

To give you some idea of Dr. Ickert's integrity he hosted a seminar where he invited speakers from all over North America to present only their worst cases. These were highly respected clinicians and are used to showing their best work to the audience. It was extremely beneficial learn that even the best can struggle and learning how they overcame the problems was very useful.

i believe you are asking a wrong question. i don’t want to make things complicated but the reality is you should at least provide a PANORAMIC Xray, so one can see the status of the adjacent and opposing teeth in order to provide you a good advice about the replacement of the missing tooth. The condition of the implant is not favorable and it is an example of “Peri-implantitis”. Lack of mobility has nothing to do with the health of an implant. in this case if you loose an additional 40-50% of the supporting bone, there may still be no mobility. Not treating and ailing implant and placing another implant next to it, caries high risks for the new implant. An implant can be placed according to ITI classification, immediately post extraction, early placement within 4-8 weeks while only Soft Tissue has healed; early implant placement within 12-16 weeks with Partial osseous healing; or Late implant placement after 6 mo, when full osseous healing is anticipated. There is no right or wrong as long as one understands what physiologically is happening and actually what needs to be done. In today’s implant dentistry world using a single PA X-ray is far from optimal treatment planning for a dental implant placement. If you care about your health, you need to gather more information. hope i could provide some useful insight to your question.

Yoicks! The priority is to remove the retained root behind the implant and then wait to see the bone response i.e. will it in-fill or will it look more like the front of the existing implant. That removal is a 4 minute procedure. The treating implant dentist x-rays should show the earlier status of the site plus the post-implant bone “healing”. Waiting 6 months allows the socket to infill with 2 advantages: 1. The free factory will produce new bone that may be able to be deposited around the old implant perimeter. 2. A post extraction socket full of bone allows a more accurate alignment than would an earlier placement wherein the socket wall often deflects the twist drill. The new implant should be replaced by a new provider ‘cause the first (one or two) should have either seen during the extraction or the implant placement or later spoken and solved the retained root.