Dental Veneers after failed dental implant

Failed implant replaced with dental veneers and bridge

Bridge or Implant (after a failed dental implant)?

Failed dental implant can be a MAJOR PIA for the patient, the doctor that placed the implant, and the restoring doctor (if different).  First off, there is the question of who’s fault is it?  Was the implant placed properly in the bone?  Was there cement left behind when the crown was put on?  Is the patient just one of the unlucky people that will have a failure (most likely)?  If the implant was placed in one office and restored in another, who pays for the failure?

Case of the week

You can see more of our cases here. We do fall behind on getting these up so it comes and goes in waves.

Failed anterior dental implant case

Beth had her implant placed elsewhere at a facility that did not have a CBCT.  It was restored by Dr. Dettmer with a beautiful crown and everything was great for about 2 years.  Then at an exam, we spotted a draining infection in the gums near the implant.  We knew this was not a good sign but were hoping it was merely cement left when the crown was seated.  Cement being left over after cementing a crown, called cement sepsis, is a major cause for many failing dental implants.  We have been able to avoid this by doing custom abutments that put the cement line higher up and by following some of these techniques.  Well it turns out the implant was poorly placed from the beginning and was destined to fail.  In this image and video you can see that most of the implant is outside of the bone.

failed implant
Implant is white in the xray and straight up

Well long story short, the implant was failing. The original surgeon removed the dental implant and the area was bone grafted. After healing for 8 months the area was still deficient and the original surgeon wanted to do another bone graft and then place the implant. Beth had had enough of the surgeries and wearing a removable temporary for all this time. She was at her wits end dealing with this tooth so we opted to place a bridge.

dental veneers
Failed implant replaced with dental veneers and bridge

Results of the failed dental implant case.

We are all happy with her end results. She was able to be done with treatment about a year earlier than the additional bone graft and new implant plan.  For those that have gone through an anterior implant failure you know they can be extremely frustrating and expensive.

How can we avoid so much money and time being spent on a failed implant or one that will likely fail soon?

One of the many things that we like about having the same office place and restore the implant, is that if one fails we can either replace or credit any money spent towards a bridge.  When placing our implants in tricky areas we use a the low radiation setting of the i-CAT flx to take an immediate post implant placement scan. This ensures that the implant is in the proper location before it heals.  We also NOW have a policy of scanning implants from other offices before restoring. This helps to ensure we are not all wasting our time and money on a loser implant.  That policy was entirely born out of the results of this case.

When is an implant a failure?

A poorly placed dental implant will likely fail but some implants that shouldn’t work do. So what is an implant failure? A movable implant is an obvious sign of a complete failure of integration. Greenstein recommends 75% bone loss or less than 3mm of  bone apically with signs of inflammation is a failure JADA 2014