Losing Bone on My Dental Implant -Too Much Cement?

Too much cement used on a dental implant crown or bridge can easily cause bone loss around both new and old implants.  It sounds counterintuitive to purposely use less cement for an implant than you would for a crown on a natural tooth.  If left untreated, it can be one of the worst dental implant complications to occur and can cause implant failure.

Unfortunately this is a complication that I see here in my office in Burbank fairly routinely.

Here is how it works:

When a crown is cemented on to an implant, the cement can get beyond the gums and touch the bone. This is possible because the gum pocket around a tooth and the gum pocket around a dental implant are very different from a biologic standpoint. Your natural teeth have a tighter seal at the gum level.

The straight red line indicates the good bone level. The dipped down line indicates the bone loss

There are different cements and bonding agents that I use for dental implants, but the bottom line is no matter what is used, the cement gets so thin, it can easily slip below the pocket.  It is near impossible for the dentist or the patient to see this.  A seasoned dental implant dentist understands this concept and should go to great lengths to prevent it.  It is based on the technique of the dentist, not the brand or type of cement.

I have developed a specialized technique for cement and bonding dental implant teeth over a decade ago.  Aluminum oxide blasting, dental implant analog cementation, and retraction cord are just a few of several techniques I use.

The center portion of the dental implant was removed by Dr. Amin. The bone loss was too severe to correct. The teeth on top stayed unharmed though.

How do you know there is too much cement?

Shortly after having a dental implant with too much cement, the gum bleeds, there may be pain and/or infection, and the gum may recede. If this is not handled quickly, permanent bone loss may ensue.  The gum usually does not grow back.  Bone can be grafted back only in some situations.

What is the disadvantage of using special techniques to use less cement?

The main disadvantage is that the crown or bridge may come out. A crown  that comes out is easily replaced, while bone and gum loss from too much cement is not easy to fix.  It is worth it.

There are many other reasons why a dental implant can lose bone; too much cement is only one of the reasons.  Please read more of my blogs and watch other videos if you would like to learn more. Dental implants are still the absolute best way to replace one tooth or all of your teeth.

Ramsey A. Amin, D.D.S.
Diplomate of the American Board of Oral Implantology /Implant Dentistry
Fellow-American Academy of Implant Dentistry
Burbank, CA

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8 Responses to Losing Bone on My Dental Implant -Too Much Cement?

  1. San M. says:

    “Losing Bone on My Dental Implant – Too Much Cement?” The Title itself makes us interested to look into the matter … I just gone through the blog and it was really an informative stuff…I hope people will find this blog helpful… good job..not too many people out there are as good as you!

  2. Olia says:

    Can too much cement be visible on regular x-ray? How doctor can see if he used too much cement?

    • Ramsey Amin DDS says:

      Hello Olia,

      Most of the time extra cement that goes under the gum line of a dental implant crown and abutment cannot be seen on x-ray. Depending on the type of cement used and the amount of cement presents it is either visible or invisible on x-ray. Sometimes the only way to know is to surgically open the area and check.

      This continues to be one of the most common problems I see in my office. The dentist who cemented the crown has no ill intentions but just does not understand dental implant crowns. Too many times people choose inexperienced dentists (based on insurance and money usually) to make their dental implant crowns which are critically important to the long term success of the implant and its surrounding bone.

      I have extracted many implants due to excessive cement left behind inadvertently. It causes tremendous bone loss.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

  3. Alissa says:

    I had an implant done about 10 years ago Nd my dentist told me I was loosing bone in that area and to make an appointment with the surgeon. I was at his office today and he said he may be able to fix it,but no guarentee in how long it will last and it will fall out. He said something like 10-10-10 on one side and 3-3-3 on the other and he would have to adjust my gum to permanently expose the area, so I can keep it clean. I was hoping that he could just put more bone I. The area and put it back. Should I see another Dr.? Did he do something wrong? I was told these last 25 years.

  4. JP says:

    I had a crown placed over a molar that was wearing thing. No root canal, and no pain prior to the crown. Following the temporary crown I had excruciating pain for about a week, and bleeding gums. Then the permanent crown went on and the excruciating pain lasted another 2 weeks. Only solution was Ibuprofin all day every day during this time. I still get pain, and cannot really chew hard foods on that side. I also have bleeding when I floss around the tooth unless I very slowing ease the floss down the sides of the tooth. It appears there is a thin line of cement at the gumline, but hard to tell. The dentist said I need a root canal, but I’m wondering if I should get a 2nd opinion from a periodontist. Any advice?

    • Ramsey Amin DDS says:

      This blog is intended for helping people with dental implant and bone graft type of questions….. But it does sound like you need a root canal….. Sorry for the bad news!!!!!

      Ramsey Amin DDS

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