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Bone Graft Correcting Dental Implant Peri-Implantitis Bone Loss ~ Case Example

bone loss on dental implant prior to correction by Ramsey Amin DDS before treatment--bone loss in the mid body of implant causing inflammation, redness and pain

Bone loss can and does occur around dental implants.  Often this is called peri-implantitis and there are a few treatment options.

Review signs and symptoms of peri-implantitis dental implant bone loss in this previous article.

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.

Correction of bone loss on dental implant--Ramsey Amin DDS

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.


IMG_0567
IMG_6892 before treatment --loose implant abutment with bone loss
IMG_6890 before treatment --loose implant abutment with bone loss
IMG_2020 10 days after bone graft--notice enlarged hump of bone over the outside of the implant
IMG_2019 10 days after bone graft--notice enlarged hump of bone over the outside of the implant

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

14 thoughts on “Bone Graft Correcting Dental Implant Peri-Implantitis Bone Loss ~ Case Example

  1. 3 1/2 yrs ago I got an implant on #4. I have been in torture ever since. The Dr also did a sinus lift at the same time. Ex-rays (from another dentist) show the sinus is entangled with the implant/bone graft. My question is, is it possible to remove the bone graft, without removing the implant?

    1. It is very common for an implant to engage the sinus floor… On purpose. Unless the graft did not consolidate and become part of your bone, it is really impossible to remove just the graft and leave the implant behind. The bone would have to be loose, non-integrated, inflamed and possibly infected for it to be causing you pain… But of course I have never seen him before. I hope this helps you answer your question.

  2. My daughter lost her front tooth when she was 9. She was told to wait until 18 when her facial bones quit growing. At 19 she had the first implant try — which failed. Last summer she had a bone graft and the implant failed for the second time this week when she had her final procedure. She was told still not enough bone. Are there any new procedures or is she doomed to wear a cemented tooth and flipper?

  3. I understand that it is possible for bone grafts to dissolve if you don’t have your implant placed within a certain amount of time (say within a year or two after the bone graft). Is this true? It has been a year and ten months since I had my bone graft and it feels like I have lost some of the bone that my doctor grafted.

  4. Hello
    Excuse me to ask you this question but I’m really confused
    I had a dental implant in the upper bone jaw, the implant apex penetrating into the sinus about 2-3 mm
    Is it okay ?
    This is my dental x ray

    Also it looks a way too close to the nearest actual tooth but i heard if it is close only 1mm, it will be fine
    What do you think ?
    Is there anything wrong with me dental ?
    I read a lot of your articles and answers and i trust your opinion.
    Thank you.

  5. my question is i have 2 implants in my loser jaw.2 weeks later(in a shelter during hurricane katrina) both crowws fell out.went back to the same dentist and was told because of my bite i stripped the crowns,i do not believe this as he charged me 500.00 extra dollars to gluue the crowns back on.needless to say 1 came off again and some how was lost. when i went to have my teeth cleaned the xrays were showing bone loss around the implants. this has been about 3 years ago. if i have to have implants removed what does this usually cost(i know u cant give an exact estimate but somewhere around it)had to go to er 4 days ago for severe pain and swelling .i am hoping u can answer this ?.thanks and god bless.peace jacqueline mutz

    1. Ugh. What a mess. The lower back teeth maybe more costly to remove the implants if they are close to the main nerve and have to be drilled out. If they are loose they can easily and cheaply be reversed out.

  6. Hi Dr. Amin,

    Thank you for writing great articles. I just had two wisdom tooth extraction – tooth #1 and 32. Number 32 doesn’t have a tooth next to it.

    I just want to know if bone graft is required for both teeth. My dentist did bone graft for both but I wasn’t told about it until during the procedure. I am now wondering why bone graft was done when I don’t have any plans to have an implant to replace my wisdom teeth. I wish I had seen your website first.

    1. Not necessary in 99.9% of cases. I don’t know what the rational would be unless you had distal bone loss on your second molars. Even then it is not needed really. Sorry.

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About Ramsey A. Amin, DDS

Dr. Ramsey Amin has extensive experience in surgical and restorative implant dentistry. As one of only less than 400 Diplomates of the American Board of Oral Implantology/ Implant Dentistry (ABOI/ID) he is considered an expert, and board-certified in dental implants. He is a former instructor at the UCLA School of Dentistry.