Rapid unexplained bone loss after re-cementation?

This patient is a healthy 45 year-old female who came in to cement her implant-supported FPD which was placed 7 years ago. The patient has a history of peri-implantitis, which was treated a year ago. One week following re-cementation the patient came back and complained of tenderness on the buccal aspect of implant #24 (first premolar). An xray was taken. 3 months later she came back with the same complaints. Another x-ray was taken which showed severe vertical bone loss. What are your thoughts on this?

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18 thoughts on “Rapid unexplained bone loss after re-cementation?

  1. Obviously this case hasn’t inspired our experts much …too bad cause it has me puzzled that much bone loss without any apparent reason. NB :the periimplantitis i a refered to was on the other side .this one is untouched .

  2. My very first thought on this is excess cement!. I say this especially because the patient experienced pain and swelling within the first week after re cementing. I would get on this right away. Also did you use a radiopaque cement and just wondering what brand because it is not visible on x ray. When I see this I try to get the bridge off and get the cement cleaned off and graft. I will be curious what my other colleagues have to say.

    1. Actually i used Fuji1 and it is radiopaque. But the thing is i cleaned the best i could .i thought the pain she felt was caused by compression of the pontic on the edentulous ridge cause the bridge was unseated for a few days.

  3. What about that canine? Is it fractured? Is the bone loss coming due to the fractured tooth? Or, Perio issues related to the canine?
    And how about heavy excursive movements on the pre-molar post recement?

    I see on the x-ray that bone loss is going on both mesial and distal aspect but I just didn’t want to leave any other etiologies out of differential diagnosis.
    If not anything else, then my guess would be cement.

    My $0.02

  4. It may be that there was not a passive fit with the prosthesis and when it was recemented. The clinician may have had the patient bite on it to maintain its position during cement setting. When this was done the non-passive fit of the retainer applied pressure against the abutment and generated a luxation. Possible.
    Dennis Flkanagan DDS MSc

  5. You noted the tissue held the prosthesis up and it was hard to seat all the way down. I submit you may not have got it all the way seated. Check for hyper occlusion. I’ve seen this in my own office and it’s been reported in the literature. In a clinical report by Leung et al, rapid crestal boneloss was associated with prosthesis hyper-occlusion appearing within 2 weeks of prosthesis delivery. Following removal of the prosthesis, the bony defect resolved, and the bone level returned close to it’s original position within a few months. When the prosthesis was replaced with an appropriate occlusal environment, bone height remained stable throughout time. This report describes how an association exists between excessive occlusal forces and bone loss, and suggested that the bone loss may reverse when the occlusion is corrected.

      1. The article is:

        Leung KC, Chow TW, Wat PY, et al. Peri-implant bone loss: management of a patient. Int J Oral Maxillofac Implants. 2001;16:273-277.

        Best regards

  6. Most likely cement under the gingiva. Surgically open with a flap large enough to see the implant and the entire defect. Clean the implant surface with citric acid / tetracycline remove infectious tissues and graft where there are bony walls to support the graft. If this condition is allowed to remain as it is the implant will be lost. Nothing to lose with trying the repair. All to lose by doing nothing.

    1. That depends Yasef. Please describe the case. When it was seated? How long has it been in the mouth? How long did it take for the bone loss to develop and what brand of implant. Lets start with this. X ray too. Dr Jim 🙂

    1. Hi Yosef, for future reference, you can always post pictures on a comment, if you are logged into your account at OsseoNews.com. When you are logged in, there is a button to upload photos under the post comment button. Anyway, we will post your case, as a new case. Thanks!

  7. Ok so there was excess cement . not loose in the gingiva surrounding the implant but bonded to the implant rough surface starting like 3 mm from the IAJ extending some 3 to 4 mm apically.this i guess means that i only aggravated or triggered a previously present situation involving buccal bone loss.so i cleaned the area .smoothened the exposed threads using fine diamond polisher. Then closed it all up .

  8. I saw the patient today .i raised a flap and what i found was glass ionomer bonded to the implant.starting about 3mmm away of the implant abutment junction and extending 3 to 4 mm more apically.i removed the cement and eliminated the exposed threads and polished the surface completely.i guess that when i cemented 2 monthes ago i had triggered a timed bomb cause obviously the buccal aspect of the implant was already exposed otherwise I would not have found the glass ionomer stock on the implant.

    1. Well I am glad you got on that Georges. I have several methods that I use and teach people on how to cement an implant crown to keep this from happening. Message me on Facebook or linked-in and I can send you some photos of clinical cases and describe these methods. Best wishes. Dr Jim Amstadt

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