Topic

[Diagnostic / Planning]  bone loss around implants


Hello,

I know bone loss around implants is a common complication and I am seeing more of it all the time.

case 1) We placed a Nobel Active implant #16 in 2016. In Nov 2017 BW showed good bone level also. The pt has since moved but returned last week saying her implant crown has become loose. She had her new DDS tighten the screw 2 months ago but it loosened again. I took some xrays and see bone loss present, especially on the distal. The crown was loose and mobile. I removed the crown and there was some food debris caught around the implant and the tissue was red and rough. There is bone loss present, looks like still on the collar. I cleaned around the implant and checked to see if the prosth screw would torque, it torqued to 35 N-cm. Appears implant is stable also. The occlusion is light and shim stock slides through easily. I am thinking the prosth screw loosened, resulted in loose crown, food collection and bone loss?

What are your thoughts?

What could cause the loosening?

How would you treat this issue?

I was thinking leave HA on, keep area clean with CHX and let tissue settle, reinsert crown again in a few weeks, likely with a new prosth screw?

case 2 and 3) implants and crowns placed in past by previous DDS, more involved bone loss present, how would you treat?

    I have seen you discuss removing crown, using I-Brush, placing bone graft material and mb using poncho technique with HA and suturing. I know the bone won't adhere/form onto the implant but is this worth trying? Any other tx suggestions.

first 4 radiographs from case 1 (2016 insert, 2017 recall, 2X 2018 losse crown/bone loss), followed by 1 each for case 2 and 3

Any advice, recommendation to avoid and tx these issues would be beneficial?

Thank-you



by Mike Budrewicz at Sun, Apr 15, 2018 10:07 AM

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Mark Kwon Replied at Tue, Apr 17, 2018 10:06 PM

my thoughts:

1. Screw loosening: common things happen commonly: Occlusion. Always check excursion as well as centric occlusion. Lateral eccentric contacts can cause this frequently.

2. Bone loss around implants: Cement / Heavy occlusion/ Emergence profile: The abutment design or the design of emergence profile of your #16 crown is too bulky; this leads to un-hygienic design and also lead to violation of biological width resulting in bone losses

3. #36 bone loss: most likely due to old 'plug-in' connection commonly seen in internal trilobe connections

4.  last PA showing boneloss: possible cause: Bulky profile / heavy occlusion / excursive force

Tx options : dethread and GBR (questionable long-term prognosis); or Explant and redo

Hope this helps,

- mark