Radiolucent halo around implant post-op: Is this normal?

I daresay that the only things that are working there are the implants. The dark areas seem to be radiological artifacts. The marginal bone looks ok and usually, with few exceptions, the marginal bone is involved early, when things go wrong.

Nice Bi-cortical fixation on the distal implant ...

The radiolucent halos are large. If they were actual lesions, I would expect a fistula at least. Secondly, two days post-op is a bit early for such a large lesion to develop around an implant. In addition to this, You would be a really unlucky guy to get two large lesions on two dinstinct implants simultaneously. Perform a periapical radiograph when you are in doubt.

If implant goes into the bone “too easy” (low torque), it means the implant well is wider than necessary and an X ray shows it. In your case. both implants have a similar bone deficiency contour.

This may be an artifact. Do monitor on a monthly basis with periapical x rays. Do no use the bur that is included with the MIS 7 implant, when placing in D3 and D4 bone. Stop at a bur that is 1 mm less in width than the platform of the implant and counter sink a little. Place a slurry of OsteoGen into the osteotomy and then place the implant (forced mineralization). Do not over torque the implant. If so, you may get a spinner. Good luck!

The graft material is OsteoGen. You can obtain it from Impladent Ltd. It's a great product. Impladent has it in tape form, which is great for onlay grafting.

We have a section on OsseoNews.com, where you can read about Impladent products, like OsteoGen, and OsteoTape.

The overall dental health of this patient is highly compromised. when was the teeth extracted and what was the reason fro extraction? why did you choose to give a cantelever? what was the torque you achieved? do we actually replace second molars? It looks you are into sinus with your molar implant, periapicals will give the best answer. But I really feel a good treatment plan was lacking.

did you change directions of the pilot drill while placing implants? The black halo isnt good, but you should take IOPA and post here. I would have grafted the first molar site, wait for 6 months, place two implants in the first premolar and the first molar site. explained the patient that she would do good even without the second molar (if money was a problem).

Hi Greg agreed I was saying it tongue in cheek as I suspect it was not the intention to enter the sinus. But we all ahve done it . Peter

Greg, OsteoGen is osteoconductive! Look it up!

OsteoGen is a Bioactive resorbable synthetic graft material. When one places it into the osteotomy, you obtain a greater implant to bone contact.

I hate to say this but this is a very challenging case for a beginner due to all the failing crowns and dental pathology on a patient with limited finances. The radiolucencies can be marrow spaces which were picked up in the cut. Did you get primary stability when placed? If so don't treat the xray. Allow at least 4-6months for healing. This might be a good case for implant retained(Locators) or implant supported dentures.

How did the bone density feel when drilling into the sites? Would agree with Richard could be an artifact and would wait 6 months and see if fill in occurs and density improves around the implants.

I forget what the condition is called but literature has shown us cases of peri-implant radiolucencies which mimicked implant failures. However, these healed without any issues. The differentiation was lack of any clinical symptoms of infection. If tissue looks good, leave as is for 4-6 months and take periapical for evaluation.

As per "forced mineralization". You can find out about it in the J Oral Implantology, Vol 26 , No 3, 2000, pp 177-184. Authors are Valen, M., Locante, WM

Richard that seems to pertain to the LaminOss implant design not sure if it occurs with other thread designs. J Oral Implantol. 2000;26(3):177-84. LaminOss immediate-load implants: I. Introducing osteocompression in dentistry. Valen M, Locante WM. Source Department of Dental and Materials Science at New York University, USA. Abstract Osteocompression is a physiologic principle that has been clinically practiced in orthopedics since the early 1900s. In dentistry, controlled functional osteocompression is the compaction created by the tapping procedure and bone lamination achieved by a sinusoidal screw implant design providing physiologic stimulation due to streaming potentials. Functionally, there is always an applied force acting on bone modified by an implant design, and there is always a resisting force acting on the implant through the viscoelastic properties of trabecular structure. Through biomechanical events in bone, osseous tissue can be stimulated within physiologic limitations by implant design to develop along the lines of compressive forces dependent on the implant load-bearing area to sustain equilibrium. At the cellular level, these biomechanical events act on the cells through a phenomenon known as streaming potentials. This is an electrochemical potential created by the flow of extracellular fluid past a positively charged cell surface. Streaming potentials have a stimulating effect on osteoblasts and osteocytes. This stimulation under acceptable physiologic limits translates to an ordered deposition of osseous tissue that aids in the support of these compressive forces. As a sinusoidal thread design, the LaminOss osteocompressive immediate-load implant (Impladent Ltd, Holliswood, NY) has shown in animal histologic observation 2.5 times greater bone lamination achieved by the function of osteocompression due to the benefits of streaming potentials created by the LaminOss implant design. No evidence of bone necrosis was observed by any of the eight implants.

Gregori, no the term does not solely relate to the laminoss design. It is placing a particulate graft material to the osteotomy site prior to placing the implant. This can be a root form blade etc. The particle size is small and you use it in slurry form or grout the implant. In theory this increases the bone to implant contact. I just happen to like OsteoGen. I have been using the material for 20 yrs with no problems and decent results. I even have histology from VCU proving that it helps to form mature (lamellar) bone.

Hi Greg , yes now you understand more about the crazy Olympic openning ceremony. Anyway the Olympics have been a blast. As to the Osteogenic debate with Richard it is always a difficult area to rate and possibly the best way to show is the increased presence of Osteoblasts around the graft material particles seen in early core samples , clearly showing the effect on the host response . We have some such samples . The Zeta potential shift to more negative can show this up-regulation as shown by Hunt and Cooper in 2007 . Kind Regards and good work with Steiner labs. Peter

Greg, you can check the Impladent Ltd web page for some of the answer. You may want to phone Impladent and ask Maurice Valen. That way you will get the answer from the source.. I will not core implants and remove them, unless there is some sort of need. I do not view my patients as science fair projects.

Gregori, I agree, the thread design is unique and a much more bio am stable design bone compression.

Baker , you are spot on. One has to obtain primary stability plus arrange for marrow blood to enter the socket.

Greg, you are welcome.

A continuation of this case is in a new post. Click here for the Radiolucent follow up photos.