before treatment–bone loss in the mid body of implant causing inflammation, redness and pain
Bone loss on implants happens on about 1-15% of dental implants. That percentage is variable depending on the experience of the dentist. How to deal with it is the big question. In certain situations your dental implant or implants can be recovered with bone grafting procedures but in some instances the bone loss associated is so significant that the only option is to remove the implant and start all over again. Bone grafting for peri-implantitis bone loss defects is not standardized and varies widely from dental surgeon to surgeon. Over many years of doing this I have developed a specific technique for recovering some of the worst bone loss.
Bone loss can occur as a “moat” defect going 360° around the entire implant or it can be just localized to one side of the implant. If it is 360°bone loss it is much worse than if it is localized to just one side. The best area to have bone loss is in between the teeth rather than on the outer aspect. This is easier to graft and has a higher success rate.
If the implant is in the front of the mouth versus the back of your mouth this can make treatment options very different also. The back teeth are more forgiving and then the front. The gum and bone is typically thicker in these areas. There are times when the final outcome leaves you with some metal of the abutment or implant showing but disease process was stopped. Of course in the front of the mouth this is typically unacceptable especially if any metal shows in the smile.
In this example case I will show you the more difficult of the two…. A case where bone was lost on the outer aspect.
In this case this is a 29-year-old female that had a dental implant placed in another country. The implant overall looks good but it has become tender on the outer aspect of the gum. One reason in her particular situation why bone loss happened was because the bone was a too thin to begin with and then the crown on the dental implant became loose at the abutment. This particular dental implant crown/abutment had a design flaw which caused loosening.
If you look at the implant on a 3-D CBCT scan view from the side you can see that in the mid body of the implant there is very little bone. Because I never treated this patient to begin with, we don’t know if the bone was like this from day one or it dissolved to this situation because of the loose dental implant abutment. Either way it needed to be treated. We discussed the possibility of removing the implant versus grafting bone and saving the implant.
If you look closely at the gum tissue, of both center upper front teeth you will notice that there is more of a hump on the natural tooth than there is on the dental implant. This was the first sign that the implant was lacking bone when she smiles. What makes this case very difficult is that the teeth are generally very long and when she smiles she shows her gumline…. Everything is going to show so this is going to be a critical surgical correction.
You have to be really careful with these cases because sometimes the correction can make the tooth look worse if it is not successful.
The most critical factor in all of this is prevention. I go to GREAT lengths to prevent dental implant bone loss from occurring in the first place by having a tremendous amount of bone on the outside of the implant if the patient’s anatomy allows. By having the original implant surgery done well, this is the best way to preserve the bone on the outer wall. Also when the crown and abutment are made by the dentist, there are so many techniques and choices to make things last and be problem free for many years. Many patients think that the crown and abutment portion are “easy” and can be made by any regular dentist. For some patients anatomy, dental implants would not be wise choice…that is the exception rather than the rule.
In her case, I am certain that the result will be long lasting. The good thing was there was no exposed threads at the very crest of the bone. The surgery was done under IV sedation through a tunnel flap which is the equivalent of a laparoscopic medical procedure. I was able to remove the crown and place a temporary crown during the procedure which helped with surgical access. The sutures seen here are designed to be dissolvable because the incision is far away from the actual tooth being treated.
I know these specific and detailed articles but a lot of this information does not exist on the Internet. I hope this helps those of you that have this problem and those of you to prevent if possible.
Ramsey A. Amin, D.D.S.
Diplomate of the American Board of Oral Implantology /Implant Dentistry
Fellow-American Academy of Implant Dentistry