Post implant question

Andrew 83

Hi all,

Back in April I had a front tooth removed and was due to have an implant. There wasn't enough bone left for the implant then however so I got a bone graft and then subsequently had the implant done at the end of August. The dentist commented at the time of the implant that the bone regeneration had been very good and much better than usual. Anyway all was good and I came back today as planned to see how it was healing. The dentist took an x-ray and there has been some bone regeneration around the implant but not as much as would be expected and nto enough to go ahead with the next stage. Given Christmas is coming up I am going back at the start of January to have another x-ray and hopefuly there will be more then - I have been told that anything by then is probably as good as it will get.

Just two quick questions:
1) Is there anything I can do that is likely to improve the bone repair?
2) If there is still not enough bone in January is it likely that I won't be able to go any further with the treatment?

Thanks

CyberJuice

could you please tell how much the treatment has cost you up untill now?

Oral Surgeon

Andrew 83 wrote: »

Hi all,

Back in April I had a front tooth removed and was due to have an implant. There wasn't enough bone left for the implant then however so I got a bone graft and then subsequently had the implant done at the end of August. The dentist commented at the time of the implant that the bone regeneration had been very good and much better than usual. Anyway all was good and I came back today as planned to see how it was healing. The dentist took an x-ray and there has been some bone regeneration around the implant but not as much as would be expected and nto enough to go ahead with the next stage. Given Christmas is coming up I am going back at the start of January to have another x-ray and hopefuly there will be more then - I have been told that anything by then is probably as good as it will get.

Just two quick questions:
1) Is there anything I can do that is likely to improve the bone repair?
2) If there is still not enough bone in January is it likely that I won't be able to go any further with the treatment?

Thanks

In these cases, I nearly always place the implant on the same day as the extraction and usually with some bone grafting then too....
If the implant site was totally gone, then bone grafting and later implant placement can be done....

What stage are you at? Is the implant still fully buried under the gum or is there a small screw sticking out through the gum??
An implant placed in grafted bone should be left to integrate for 3-6 months depending on a load of different factors but really this should be predicted at the implant placement surgery.
An xray at this point may show 2 things; an implant surrounded by bone (good) or the possibility that some some tissue or infection has interfered with the bone to implant interface (bad and seen as a black area beside the implant on xray). If the xray looked bad, leaving it a few weeks or months is not likely to make the situation any better...

To answer your questions;
1. not really at this point, just keep the area clean
2. depends on the problem, if the implant is failing, it will need removal and start again.... there are loads of possibilities here, we need more info to say...

OS

davo10

OP you and your dentist are doing exactly the right thing. Sufficient bone was not present in April for an implant, the surgeon augmented your bone with a graft to increase bone mass and retention, the implant was placed when bone grafted successfully, it is now probably taking a bit longer for integration because of grafting and the surgeon is prudent and wise not to "load" the implant with a crown until he is certain that conditions are right. If I can use an anology, it is like waiting for a foundation to set fully before building a house, if it is not fully set, the house has a greater risk of falling. Be patient and listen to the surgeon, do not smoke and if you are wearing a small denture, leave it out as musch as possible because the constant pressure on the implant site can slow healing. Remember you want this to last a lifetime so wait till everything is ideal.

OS I disagree with you completely. This is exactly not the time to place an immediate implant because:
1. If there was extensive bone loss at time of extraction it suggests a history of ongoing pathology such as an abcess or cyst, both contraindicate immediate placement.
2. If buccal bone has resorbed, you are gaurenteed to fracture/fenestrate it during preperation on implant site.
3. If placing immediate implant, the diameter must be wider than the root so as to engage the socket walls and gain primary stabilisation, if there is reduced bone mass this leads to fracture/fenestration/"warping" of buccal surface of ridge.
4. Osteoclastic activity/resorption leads to bone loss after extraction, this makes bone levels unpredictable and can adversely effect the gingival level and therefore aesthetics.
5. Bone loss around the neck of the implant and the formation of a new "biological width" (approx 2mm is during integratory phase) means that if there is little bone there to begin width and a graft is done, you have no idea weather the neck of the implant will end up being exposed.
6. The OP most likely wearing a partial denture replacing his front tooth, the constant pressure exerted by this on the graft and immediate implant would jeoprodise integration.

Immediate placement demands ideal conditions and bone levels, an example of this is post extraction of a healthy tooth after trauma.

OP again, everything is going along as it should be, you just need to wait a little longer.

btkm8unsl0w5r4

I think the answer is it depends. There are times when you should place the implant straight away and times you should not. You own surgeon will advise which is best and it depends on a number of factors. The literature show similar success and aesthetic outcomes with both techniques however personally I like to immediately place where possible as there are fewer surgical procedures. It depends on who is doing the surgery and their ability to control graft and membrane. Always fixed temps. I have put up a post in the lounge for the dentists with some literature.

Oral Surgeon

davo10 wrote: »

OP you and your dentist are doing exactly the right thing.

If you read my post again- you will see that I did not disagree with the treatment provided.

davo10 wrote: »

OS I disagree with you completely.

What's new? If I posted that a tooth was made from enamel, dentine and pulp- I'm sure you'd have something to say about it....

davo10 wrote: »

1. If there was extensive bone loss at time of extraction it suggests a history of ongoing pathology such as an abcess or cyst, both contraindicate immediate placement.

Not what the op posted...

davo10 wrote: »

2. If buccal bone has resorbed, you are gaurenteed to fracture/fenestrate it during preperation on implant site.

This only matters if doing a flapless placement, if it perfs when a flap is raised, you can just graft the exposed area...

davo10 wrote: »

3. If placing immediate implant, the diameter must be wider than the root so as to engage the socket walls and gain primary stabilisation, if there is reduced bone mass this leads to fracture/fenestration/"warping" of buccal surface of ridge.

Immediate placement gains stability from apical threads. The coronal area can be grafted, covered with a membrane or if you beleive Dennis Tarnow- just left exposed to heal by secondary intention.

davo10 wrote: »

4. Osteoclastic activity/resorption leads to bone loss after extraction, this makes bone levels unpredictable and can adversely effect the gingival level and therefore aesthetics.

Osteoclasts are always remodeling bone, sure enough more so after an extraction but also after an implant is placed too. Proper implant placement and use of graft and membrane can maximize retention of the patients own bone.

davo10 wrote: »

5. Bone loss around the neck of the implant and the formation of a new "biological width" (approx 2mm is during integratory phase) means that if there is little bone there to begin width and a graft is done, you have no idea weather the neck of the implant will end up being exposed.

Same as no.4

davo10 wrote: »

6. The OP most likely wearing a partial denture replacing his front tooth, the constant pressure exerted by this on the graft and immediate implant would jeoprodise integration.

Must have missed that, don't think the op said that... I use fixed temporaries so don't have that problem...

davo10 wrote: »

Immediate placement demands ideal conditions and bone levels, an example of this is post extraction of a healthy tooth after trauma.

Yes this is a good example but most certainly not the only situation where this treatment option can be used

davo10 wrote: »

OP again, everything is going along as it should be, you just need to wait a little longer.

OP, Davo10 has no idea how everything is going for you (and neither do I from your post) but I asked some questions to try to clarify things a bit and not just presume all is ok

Thanks for your input Davo10

OS

Andrew 83

Thanks all. I do have a removable denture that I wear and I tend to wear it almost all the time apart from when I'm sleeping so perhaps that has had a part to play. The original tooth had actually been knocked out years previously and then put back in and given a root canal then had to be removed now due to resorption.

CyberJuice - It has cost about 2,000 or so so far but that is included extraction and bone graft which not everyone would need. The implant itself was about 1,300 or so. I will have to pay another grand or so for a crown at the end of the process as far as I can tell.