Radiolucency adjacent to implant: thoughts?

This patient is a healthy 30 yr old male who had this implant placed due to congenitally missing left mandibular second bicuspid. The primary tooth was extracted more than 10 years ago. He declined orthodontic treatment prior to implant placement. A Nobel Conical Connection implant was placed surgically with healing abutment for 4 months (first PA). Healing period was uneventful

An impression was taken after 4 months and the tissue was healthy, no inflammation was present and the implant was integrated. An x-ray was taken to confirm seating of the impression coping (second PA) and a small radiolucency was visible on the mesial of the implant body. Comparing this to the x-ray taken at the time of placement there was also some radiolucency at that location at that time as well. Therefore this was determined to be a bone marrow space / trabeculation.

The crown was placed 3 weeks later and an X-ray was also taken that day. Again there is a radiolucency in this area (mesial of implant) which is consistent with the previous x-rays. Again there were no symptoms, no inflammation, and the implant is integrated. The implant crown is protected by good canine guidance and there is absolutely zero contact on excursive movements and there is also shim relief in centric. Because of this the implant will not be subject to excessive occlusion forces. The soft tissue is healthy. I advised that we would monitor this site closely taking a PA in 4-6 months time to check for remodelling. This is my approach at this time.

Is this simply just the bone architecture in this area or are we seeing something more that this?

15 Comments on Radiolucency adjacent to implant: thoughts?

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Neil Zachs DMD, MS

11/18/2019

The implant looks integrated for sure. The lucency could be anything...marrow space, residual defect etc etc. You should take a CT scan to be sure. The biggest issue I see is that the implant was placed a bit too far sub Crestal. That to be is the most glaring issue. Neil Zachs Periodontist, Scottsdale AZ

Dan

11/18/2019

It could be the result of bone level discrepancy between the buccal and the lingual.

roadkingdoc

11/18/2019

The abutment doesn't look parallel to the implant. Is it fully seated?

roadkingdoc

11/18/2019

Looks tipped distally. I have had some these deep fixtures get hung up on bone during placement.

Carlos Boudet, DDS DICOI

11/18/2019

The lack of bone adjacent to the implant could result in bacterial ingress and peri-implantitis. You can observe for any signs and treat if they are present.

Peter Hunt

11/18/2019

The radiolucency was there when the implant was placed and it has remained unchanged over the last few months. Your idea of watching this and taking periodic radiographs seems entirely appropriate. Good Luck with it.

Dr. Gerald Rudick

11/18/2019

The implant was placed very deep in relation to the crest of the ridge...… the abutment or post of the crown is in contact with the bone and does not promote osseointegration, and this is a possible source of periimplantitis. A possible remedy to this situation would be to remove the crown, reduce the bone to the level of the implant, some grafting may be needed., put on a cover screw and let it heal for a few months. If the situation clears up, make a new crown.

samiam

11/18/2019

As the radiolucency was present at impression time, its not likely related to the final restoration. Not sure what it is, but since its not clinically broken, I'd wait before I "fix it".

Sajjad A. Khan

11/18/2019

Take following actions if it makes sense to you: >Exposed the defect area by reflecting the FT flap then explore the area for any foreign material such as Impression material etc >Use ND laser decontaminate the implant surface then graft the site with patient's harvested bone make sure NO occlusal load on the implant crown., very light or no mesial contact on the Crown . >Keep patient on Augmentin for 10 days .

Sajjad A. Khan

11/18/2019

> Also lighten up the Distal contact

Hans-Jurgen

11/18/2019

The radiolucency may well be due to the fact that the implant has been placed below the top of the bone level, and the mesial side of the bony rim is shortest and could allow bacteria a shorter access track along the implant shaft to initiate Inflammation/infection/bone invasion laterally and mesially. It would be more ideal to have placed a single implant shaft that protrudes through the overlying bone and gingiva to be clear of and over the living tissue with provision for the top of the implant shaft to support the eventual crown to be placed/seated/cemented/locked upon the entirely tissue-supported implant shaft. That arrangement would eliminate the built-in "crack" between the two implanted shaft pieces that have been placed one on top of the other.

Charles

11/18/2019

We’re programmed to find negativity (pathology) 8x stronger (Thinking fast and slow Daniel Kahneman) so without further conclusive evidence this is possibly Differential absorption of XRays being reflected by implant material and surrounding tissues ?? ( we often see these shadows surrounding perfectly “sealed” old amalgams, screws etc)

Dr. AA Conradi OMFS DMD

11/18/2019

The edentulous ridges of congenitally missing teeth are notoriously knife edged, that is ( if I may assume) why the implant was ‘buried ‘ subcrestally. Perhaps the ensuing thin labial bone got microfractured in a ‘green stick ‘ fashion during final seating, hence the lucency. A pre op x ray would be helpful... Regarding the final x ray, we see the usual creeping of the pseudo PDL to 1.5 mm below the micro gap . A totally predictable outcome . Grafting will not change this . Long term prognosis is definitely guarded . However good hygiene and prosthetic stability ( check seating and screw torque) will keep the fixture integrated as long as 1/3 stays in stable bone . Annual 3D and clinical f/u are indicated to document a base line .

Timothy C Carter

11/19/2019

So clearly this case has been critiqued so I will not go there. I think what you see is simply a variation of normal and I would not loose a minute of sleep over it. I do agree that the abutment might not be fully seated but that is obviously not the cause. As for the person who said "grafting might be necessary"........ What exactly about this case would require a graft and what would you expect it to accomplish?

Corina Pintea Ceacoschi

11/19/2019

My opinion is that there is a bone loss. The radiolucency wasn't there when the implant was placed.