Replacement of cemented implant with peri-implantitis?

I have a patient who presents with an implant of unknown brand placed 15 years ago which currently has peri-implantitis.  The patient wants the old cement retained PFM replaced with a Zirconia crown and Zirconia abutment.  The implant has crescent shaped bone loss to the middle third.  The CBCT scan shows a fenestration towards the buccal surface near the apex.  To treat the peri-implantitis I plan to debride and place a bone graft with GBR.  I am unsure how to proceed with the prosthetic challenges of an unknown implant system.  Can anybody identify the implant used?  Can you recommend a course of prothetic treatment for the abutment and crown?

11 thoughts on “Replacement of cemented implant with peri-implantitis?

  1. michael dds says:

    Fenestration repair is probably first concern. Re: Zirconia….not sure why pt wants replacement. There is a risk when removing existing crown and abutment. I had case one time where 15 year implant, unknown type, abutment came loose. I cut off crown but could not retighten abutment. Ended up burying implant and placing bridge. So, anyway….two unknowns here….outcome of surgical repair and placing new crown. Options: leave crown as is (safest)…cut off crown and leave abutment, you can still do zirconia crown. Seems like trying to replace abutmentnis the most risky path.

      • Perioperry says:

        Yes, yes, yes! There is too much loss of bone and too much deficiency of ridge to warrant trying to rescue implant. Take it out, rebuild ridge, re-implant, then restore. Otherwise you’re asking for a host of problems. Other option would be to explant, augment ridge for esthetics, then do a 3-unit fixed bridge.

  2. J Lee says:

    It looks like Nobel Direct – one body implant. If I am right, you cannot replace it with zirconia abutment. So I recommend removal and replacement of it.

  3. Dr R Y says:

    Good debridement, 3 to 5 laser sessions for peri- implantitis, GBR, wait for 3 month if you found improvement leave the crown intact if it is functionally and aesthetically fine.

    • Raul Mena says:

      Dear Dr R Y
      If you do that you owned, and what about the bone defect in the area of the buccal plate.
      Have you seen the signs on a Fine Glass Stores?
      “If you braked you owned” that applies here.
      I do Expert Witness reviews for the DEFNESE and you could be in a lot of trouble by doing the treatment you propose.
      Guys, if you want a pet avoid Cobras.

  4. Don Rothenberg says:

    Remove the implant. Don’t take on this problem!
    Remove…graft site with PRF/FDCCB 50/50…4-5 months place a new implant correctly and restore.
    Your patient may not like to hear this but it is the only way to get a predictable longterm result.
    Good luck!

  5. Barrow Marks says:

    Can we get down to basics. I see two central incisors a lateral incisor a canine and a premolar that will all need full coverage in the near future. Take out that implant and make a beautiful zirconia bridge. I have been in practice for 45 years I have placed many implants and many more fixed bridges. Most of my fixed bridges are still functioning for anybody who is still alive. Stay away from an unpredictable and bloody affair when you have a sure thing as a choice. You will make your patient happy, you will make yourself happy, you will make your laboratory happy, and you will make me happy. I love you guys.

  6. implantsdr says:

    Thanks a lot everyone for your valuable advice.

    The patient was informed of all risks and complications associated with the procedure to retain the same implant and was also advised for a new implant ,but he was willing to take a chance and gave the consent.

    The PFM crown was needed to be replaced not only for aestheics but also as the gross overhangs were probably causing the bone loss.When we raised the flap there was no fenestration but the bone was very thin labially.We removed the old crown,made a new temporary for the prosthetic part temporarily.We were lucky to have a one piece implant with no abutment to worry about .
    Thorough debridement of all granulation tissue was done followed by irrigation with clindamycin and normal saline .The bone surfaces were decorticated and GBR performed.

    We are hoping for the best and will wait for 3-4 months before deciding to replace the temporary with the zirconia crown.

Leave a Comment:

Comment Guidelines: Be Yourself. Be Respectful. Add Value. For more details, read our comment guidelines. Though we require an email to comment, we will NEVER publish your email.
Required fields are marked *

Posted in Clinical Cases, Surgical.
Bookmark Replacement of cemented implant with peri-implantitis?

Videos to Watch:

Dental Implant for Lower Right Second Molar

This video shows implant placement on the lower right second molar.[...]

Watch Now!
Saving a Bridge with Periodontal Therapy

This video shows a case involving a 48-year-old male who was referred for periodontal treatment[...]

Watch Now!
Immediate Loading Full Arch

This video shows a case of Immediate loading of a full arch with simultaneous guided[...]

Watch Now!
Apically Repositioned Flap Technique Around Implants

The apically positioned flap is a commonly used surgical approach, that may help the long[...]

Watch Now!
Digitally Planned Bone Augmentation and Immediate Implantation

This video shows a case using the Ring technique to provide bone augmentation along with[...]

Watch Now!
AnyRidge Implants: Replacement of Upper Left Molars

This video shows the replacement of maxillary upper left molars with Megagen AnyRidge Implants.[...]

1 Comment

Watch Now!
Guided Implant Surgery & Immediate Temporisation

This video demonstrates the placement of a missing pre-molar using computer-guided surgery and immediate temporization.[...]

1 Comment

Watch Now!
Implantoplasty to Treat Peri-implantitis

This video shows the use of the Implantoplasty technique to treat peri-implantits. Granulation tissue and[...]

9 Comments

Watch Now!
Placement of Implant Using EZ Devices

This video demonstrates the placement of a dental implant in the upper jaw using the[...]

Watch Now!
BonePen: Improve Positioning of Implants

A short video demonstrating close up the use of the BonePen Kit, a set of[...]

Watch Now!
Vertical and Horizontal Bone Augmentation with Khoury Bone Plates

This video shows a way to utilize thin autogenous bone plates to create stunning bone.[...]

4 Comments

Watch Now!
Maxgraft bonering: immediate implant placement

This video shows a live surgery using the maxgraft bonering, which is a pre-fabricated[...]

1 Comment

Watch Now!