Dentaltown August 2019 - 40

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6D1R3
Member Since: 03/02/06
Post: 8 of 87

Yes. Flapped at time of surgery-nothing significant that I saw, as far as I can remember.
The crest was narrow buccal lingually, so it would make sense if the bone loss was lingual or buccal (which is usually why you see resorption on these cases if all else was good during surgery). ■
4/5/2019

4th Crown and Long
Member Since: 01/21/15
Post: 9 of 87

6D1R3
Member Since: 03/02/06
Post: 10 of 87

What have you told the patient? These are always really tough cases to treat. ■
4/5/2019

We told the patient that the implant is questionable and may have been rejected by her body,
and that we'll take new X-rays and look again in a few weeks to make a final determination. ■
4/5/2019

CREAM
Member Since: 11/16/10
Post: 11 of 87

The dimensions of the radiolucent shadow along the crest in the preop film correspond to
the depth of vertical defects along the implant today. The body did not reject the implant. Due
to the unintegrated microthreads, the implant will be chronically inflamed if restored. ■
4/5/2019

johnstondmd
Member Since: 09/10/13
Post: 13 of 87

You mentioned that the ridge was thin. This would be a great opportunity to explant with a
simultaneous socket-onlay graft to gain a little buccolingual ridge width. I bet you'd feel much
better in a few months with another implant placed slightly subcrestal, with an extra couple
mm of buccal bone. It'd be different if she was 91, but she's 19. You want this thing to be as
bulletproof as you can make it. ■
4/5/2019

ggsteiner
Member Since: 02/22/10
Post: 14 of 87

The site you placed your implant in was very poorly mineralized and composed primarily
of fat cells. In these cases, because of the lack of cancellous bone, the alveolar crest develops a
cortical plate to compensate. Because implants are not designed to be placed in cortical bone,
you fractured off the cortical plate distal to the implant. You can see the fracture line under the
distal cortical plate when the implant was placed.
The cortical plate has sloughed off during healing, producing apparent bone loss. The implant
has not failed but is surely compromised, and if it was my implant, I would graft the defect distal
to the implant before restoration. The surface is not chronically contaminated, so minor treatment
with citric acid or tetracycline should remove any pathogens or toxins. Then graft and membrane. ■
4/10/2019

florida gator doc
Member Since: 07/10/05
Post: 15 of 87

Greg, you continue to offer interesting alternative explanations. I'm not sure I quite understand it or agree, but it just goes to show that we can all look at the same radiograph and draw
different conclusions. ■

4/10/2019

6D1R3
Member Since: 03/02/06
Post: 17 of 87

As someone whose opinion I and the rest of DT respect a lot, how would you treat this case?
(I thought about Greg's idea for grafting, but am not sure how predictable it would be-at least
in my hands.) ■
4/10/2019

florida gator doc
Member Since: 07/10/05
Post: 18 of 87

The key, IMO, is the morphology of the bone defect around the implant. It always looks worse
clinically than it does radiographically. Most clinicians realize that implants don't lose bone just
medial and distal-it's circumferential bone loss. There are two paths in implant repair: respective

AUGUST 2019 // dentaltown.com

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Dentaltown August 2019

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