Bridge or Implant (after a failed implant)?
Case of the week
A failed 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?
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, I spotted a draining infection in the gums near the implant. I knew this was not a good sign but was 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. I personally 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 was placed outside of the bone.
Well long story short, the implant failed and was removed 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.
Her results turned out nice and she was done about a year earlier than was planned with the additional bone graft and new implant. For those that have had to endure a failed implant it can be extremely frustrating and expensive. One of the many things that is nice about our practice, where I both place and restore my own implants, is that if one fails we credit any money spent towards a bridge. The other nice thing is that with the very low radiation of the new i-CAT flx scan we can take an immediate post implant placement scan to ensure that the implant is placed in the proper location before it heals. We also have instituted a policy of scanning implants placed at other offices before restoring to ensure we are not all wasting our time and money on a poorly placed implant. That policy was entirely born out of the results of this case.