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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

14 thoughts on “Losing Bone on My Dental Implant -Too Much Cement?

  1. I just finished my implant procedure 3 days ago with the cementing of the crown. I wish I had found your web site before that day! Now I’m terrified about the possibility of peri-implantitis from the cement used to attach my new “tooth.” My dentist didn’t do an x-ray after the placement. How concerned should I be? Should I make an appointment with my dentist right away to address this concern? I’m annoyed that I wasn’t given the option of a screw-attached crown, which is the option I would have chosen had I been aware. Thanks for some very helpful information!

    1. Just go back and have a simple X-ray done. I’m sure it will look fine. Screw attached teeth are not without problems and are not a cure all for cement issues. I probably do 50/50 cement and screws.

      Screw teeth can break and are many have cemented parts at the abutment junctions where zirconia meets the titanium.

      An X-ray after it is placed is always a great idea. All of these issues usually arise from technique errors not the cement itself.

  2. Hi doctor

    I am in the process of getting an implant, the next step will be cementing my crown. My dentist seems and claims she’s got good experience but given I am terribly scared of her doing a bad job and getting peri implantitis maybe losing bone and more teeth/molars, how can I help make sure she uses little or about enough without offending her?What can I do to make sure its the correct amount or less than necessary? how much is this quantity? (in oz.?)

    I want to trust my doctor but definitely I feel one cannot be too sure. Appreciate it.

    1. There is no measurement for it. We just described it as a very light lining of cement. Even if you use a bit too much it’s just important to clean the excess out and take a x-ray afterwards to make sure no cement is visible under the gums where it cannot be seen by the naked eye.

  3. Had 2 dental implants following a bone graft about a year ago. Recently, I noticed some bleeding and irritation from the area. I visited the periodontist and he removed excess cement from the area.

    He also told me that there is 50% bone loss inn the area.

    What are the chances that my implants will now fail? Should I be upset? The periodontist told me that things like this happen when dealing with implants.

    1. Ugh….bad story… I am sorry you’re having trouble. Speak to your periodontist about the possibility of bone grafting around the existing dental implant. Sometimes it has a very good prognosis and sometimes it does not. This is a very technically difficult bone graft to do. I would suggest combining graft material with a biologic enhancers such as L PRF and/or PRP.

      It may be less costly, more predictable to just replace the entire implant again. Sorry for the bad news. Cement gets beyond the abutment and onto the implant it is almost certain death from the bone.

      Happy Thanksgiving

      Very respectfully,

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

  4. 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?

    1. 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

  5. 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.

    1. Hi Alissa,

      There is no way to guarantee anything in the human body. People get hip and breast implants all the time that did not even last 10 years. The condition you likely developed is call peri-implantitis and can often be treated with a complex bone graft. The situation has to be just right, for it to work. If not, you may want to consider the surgery that has been recommended or remove this implant and replace it with the new one.

      I know you are really bummed out about it but at least it is not your kidney or liver that is failing.

      I would suggest that you have growth factors made from your own blood added into your graft if you’re going to have this procedure done.

      What is Peri-implantitis and What Do I Do About It? – Bone Loss Around Dental Implants ~Burbank Dentist, Ramsey Amin Reviews

      Do I Need PRP/PRF/PDGF/BMP For Dental Implants and Bone grafts?


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

    1. 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

  6. “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!

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About Ramsey 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.