[Others]  Progressive bone loss 4.6 implant

Hello all,


I have a patient that had two BioHorizon 5.8 by 15mm implants placed in 2011 in 4.6 and 4.7 areas.


Patient has progressive bone loss with buccal probing depth of 7mm (was 6mm last check) on 4.6, all other probings are 3mm. 


The crowns are NOT splinted and I had the patient show me that he can floss in between the crowns. He flosses every day. 


I checked occlusion, although not perfect it is more along the axis on 4.6 rather than 4.7 despite the issue being on 4.7. 


I gave the patient CHX rinse with Amox prescitption for now while i figure out the best course of action.


What are some suggested reasons for this as well as treatment options?


We do have a diode laser as well as access to PRF and bone graft material should we need it?




by Ilia Oukhalov at Tue, Jul 5, 2016 4:36 PM

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Mark Kwon Replied at Wed, Jul 20, 2016 7:03 PM

I would avoid high heat laser of any sort. bone and implants don't do well with excessive heat. Dr. vans uses waterbased laser i believe which is the gold standards. Typically pocket depth around implant restorations will be deeper than what you find around the healthy normal dentitions, mainly due to lack of sharpie's fiber. (remember we covered this in the course? ^^) Thus, pocket depth alone does not concern me. More accurate question should be "Is tissue healthy? is it exudation under palpation? Is the bone loss progressive in nature? ..." I do see bone loss distal of the #46. However you stated that 'the issue is more with #47"??? please clarify what is the real issue here. debridement of localized pocket can be achieved using flap and i-brush (surgical smart) and GBR to prevent further bone losses if indicated. thanks, - mark

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Ho-Young Chung Replied at Wed, Jul 13, 2016 12:14 AM

Hi Ilia, It's hard to say whether this bone lose is progressive based on one set of radiographs. PDs can vary between individuals and between session for the same operator. There certainly has been bone loss at the distal of 46 implant. However, whether this should be treated depends on whether there are signs of infection. If you haven't already, please check for exudate from sulcus when pressing on buccal and lingual tissue with cotton tip applicator. Etiology must also be addressed. There may be excess cement in this area that is not showing up on the radiograph. Not all cements are radio-opaque and even if they are, they don't always show up on radiographs. A diode laser isn't all that useful for implant debridement. Dr. van As has given some lectures on implant complications and my understanding is that a hard tissue laser is best. PRF is great but it is not magic solution that will grow bone. Aetiology needs to be addressed and the site needs to be appropriate for bone regeneration. Ho-Young