Possibility Implant Has Moved?

Anon. asks:
I know that this case will sound weird but it left me clueless and I wanted to see if anybody had the same experience. I placed a dental implant in May 2005 for #13 (4.1x 11.5 non-immediate) in a 2 stage scenario. The patient moved out of state and did not return for completion of treatment. He came back in January 2007 and I exposed the implant and placed a healing abutment. Again he disappeared for 1 year and came back in January 2008 for the restorative phase. I noticed that the implant is now positioned very much buccally. I was surprised because I was almost sure that I did not place it in that position (I used a surgical guide). I checked my photographs of the placement and found that I had placed the implant in the middle of the ridge (in alignment with the central groove of the adjacent teeth). Is it possible that this implant has moved? I know that this sounds crazy but I do not have another explanation. I will appreciate any help in finding the clue for this puzzle.

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19 thoughts on “Possibility Implant Has Moved?

  1. Movement has to be related to the position of something else. Is it possible the buccal plate was compromised and therefore resorbed back making the implant appearing to being more buccal.

  2. I think Hoos is on the right track. Did you do this flapless? If so, easier to compromise buccal plate resulting in resorbtion making relative position of the implant seem buccal. What type of implant? Seems that you noticed difference after exposing and placing healing abut. in Jan 07. It should still be aligned with the central groove of the adjacent teeth. Interesting—hope this helps to generate some thought/discussion.

  3. If you have a photo of the implant in the middle of the ridge presumably you must have raised a flap to see the ridge? Typically you will get more buccal bone resorbtion with this over a transmucosal approach. The other questions are 1) how old was the pt? there is still bone growth up to possibly 25 in males, would this acount for any apparent movement? Perhaps it is everything else that has moved and the implant stayed where it was put and 2) was a temporary denture worn? This might cause excessive bone resorption around the implant especially buccally. I am sure there is a more rational explanation than it has actually moved but nothing surprises me so perhaps it did????

  4. Sorry, just to add, and this might not be relevant in this case, but it might. If the implant was placed at an angle so that it faced buccally, once the implant was exposed and the healing abutment fitted the gingiva would be heaped buccally giving the appearance that there was more tissue buccally. If the implant was at an angle the gingiva would shrink both buccally and apically possibly giving the appearance that the implant had moved. Just a thought.

  5. Another thought, if the location or angulation has actually changed, there may be some trauma involved. Auto accident, bar fight, bruxism… Someone who periodically disappears may have other things “going on” and not volunteer information.

  6. at the same time , we have to accept the un ideal situation of losing close follow up of the pt. i find big part of the problem is there… a thought to add.

    my explanation: due to the prolonged time of mng , buccal plate resorption occured with soft tissue compensation, both gives the illusion of buccal malposition.

  7. One of my older patients(60) received by referral two implants in the mandible 35/45 with cantilever 36/46. This is a free end situation and the patient (fysiotherapist) is a bruxer. Two years later the cantilever-parts have moved buccaly and there is a gap between the 35/34 and 45/44. There is problem with the abutments on the implants.Althoug the rest of the dentition seems not to have altered, the implants have defenitly taken an other position in the mandible. It is possible to compare OPT’s on the position of the implants.
    I thought I was the only one with an observation like this, but since a red your little article I’m convinced this is a new devellopment.

  8. I agree with the assumption that change of position of the implant is moreover the result of bone resorption on mostly the buccal side. This might give the appearance of movement.
    However, I have one post-trauma case in which two implants were placed in an edentulous mandible, where I had planned a secondary correction of the lower lip during the second stage procedure. In order to have some support for the soft-tissues after the second stage procedure, impressions were made directly after implantplacement. During the second stage procedure the bar would not fit on the implants, as if the implants had changed in angulation by some nanogrades or nm’s or whatsoever. Many other reasons can be found to explain the non-fitting of the bar, but still…

  9. I posted the question. First thank you all for your comments. I place the implant with a flap raised and not flapless, although I raised an envelope flap with minimal reflection of the buccal bone. The buccal plate has suffered from resorption making the implant appear more buccally but also and very important that the implant is very buccally positioned when comparing it to the adjacent teeth “not the buccal plate”. As I said, it was aligned with the central groove of the adjacent teeth, and now it’s aligned with the buccal cusps of the adjacent teeth!!! I hope that this will give you a better idea about my observations.

  10. Moving implants as we all agree do not make sense
    It cannot be done othodontically and they do not move by themselves
    the “apparent” movement can only be relative …tissue resorbtion scince placement and/or increased bunching of soft tissue
    Both have been suggested

    The priciple of “Ockhams razor” my apply
    “All things being equal the simplest solution applys ”

    Namley that you placed the implant into this position in the first place!
    This angulation is very common in the pre maxilla and happens all the time ..splint or no splint
    I certainly cannot recal the position of placement of of an implant I did 2 years ago..I am sure you will will find a prosthodontic solution unless its way out .

    This

  11. There are mainly 3 possibles answers here
    1.- you placed it in that posiition
    2.- the buccal has resorbed and maes it look like the implant has moved.
    3.- this is a young patient and has had a growing peak or fase and that made the implant stay back and up.
    cheers

  12. Once integrated the implant CANNOT move in the bone. It could b the bone fractured and realigned or buccal resorption giving the appearance of relative movement.

  13. A way out thought, has the patient had some sort of trauma and had the original implant removed and a second implant placed, a lot of time has elapsed between you placing the implant and the patient returning for completion of treatment?

  14. Dr. Bergman
    Come on now Dr. Bergman, you should know better than to lie on a public forum. The XiVE 3.0 with the superb SLA surface has been approved and used in North America for over a decade. And I am certain you know all about it.
    There has never been a fracture or failure of implant body. It is approved for use in the upper lateral and lower incisor regions for single tooth or splinted bridge replacements. This in not an implant for overdentures in narrow ridges, but for single tooth replacement and/or immediate temporization, nothing beats it.

  15. I cannot do anything but speculate but here is my 2 cents. If there was not a buccal flap exposing the plate, placement is a guess. If the surgical guide was locally fabricated, it is still a guess. If you want to see a gross failure from an immediate implant extracted, sounded and assumed to be there but probably was deficient in B/L dimension, go to the cases here. Anyway, my experience and failure leads me to this possibility. The implant was placed, there was a fracture of the plate during sx or expansion, there was a thin biotype, and the implant possibly migrated during the first month and came to its position bucally before integratintion complete. It simply had to either be placed there initially or migrated prior to integration. If you wobble in the site, overheat it, expand it, fracture it, or even have periodontal involvment be it dehiscence or fenestration or tissue, I can see how the implant could end up on the buccal aspect but I would think it would be from mechanical preparation, positioning or encroachment. Even with all of these possibilities mentioned, the resorption of the plate and tissue will yield the same appearance. I dont agree with the fact that it just “moved” without their being a significant early surgical component. In looking at my 2 failures with the buccal plate so far, both implants were still appropriately positioned where I placed them. They just failed because I missed something during placement. The third failure was a spinner on a senior individual that just didnt have it in her to make good bone. This one sounds like it was an early failure. also, look at the medical hx and age and meds. For what its worth. Bill

  16. Did you ever question movement of adjacent teeth? They can move lingual increasing appearance of buccal bone loss, possibly explaining why buccal cusps are lining up with implant center now…

  17. Dr. Jeff, you’re BRILLIANT! We all missed that one. I like it. The implant is the same, the other teeth moved. Simple if he has 50% bone loss, always possible. Look for scalloped borders on the tongue and ridges inside the lips and cheeks. He’s got a sucking (reverse tongue thrust!) habit. Some medications (especially anti-depressants) trigger a sucking habit.

    Cool, I always like finding another solution….

  18. Dear Anon,
    What happened is obviously an alien abduction. While doing an extreme MRI on it, it moved. Please double check with your patient.
    OK OK, I am just joking!

    It could be that after you placed the healing abutment, the patient accidentally bit on a hard piece of nut or some such thing that is hard and large which we sometimes insist on placing into our stoma in order to masticate and consume it. The hefty crunch was so hefty that it actually caused the bone to give way, but not the periosteum though…… and the whole implant moved 2mm. After that horrid experience, the patient decided to give it a prolonged and careful rest and ate on the other side most of the time and lo and behold, the implant reosseointegrated again in its new location. Over the extended time that you mentioned, the patient selectively forgot about it or chose not to mention it in case you blame him/she for any residual problem. I could have sworn that that is what happened to one implant I placed several years ago.

    Cheers!

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