Dental Veneers after failed implant

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.

failed implant

Implant is white in the xray and straight up

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.

dental veneers

Failed implant replaced with dental veneers and 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.

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  • Waldez

    Most, 85% or more according to Osseo News, Dentists have no fear of legal action regarding implants – get them to sign a waiver. Most Dentists also admit to implant procedures in patients with very little chance of a positive outcome – why insurance won’t cover implants. Most patients have no concept or the ordeal which will arise from receiving implants and regret the decisions as the surgeries never seem to end – indeed many elderly patients die before their implants are ever successfully completed. Once dentists start placing implants, the money is so good that it changes their outlook on all procedures and dentists begin to pressure patients. Honest dentists are not graduating a rate above %5 of their Dental School Class. Most Residents desire only to do implants because that’s the big money, so beware. Overall not something to be proud off.

    • bryanabauer

      I agree. The implant bubble will pop and the overuse will return to normal. Pre-op CBCT and immediate post-op CBCT show many implants have far too little bone to be placed in many areas. More bone grafting procedures will need to be done to place an implant properly in the future. It won’t be long until most docs have 3D printers in the office to print custom guides for every case. That will help immensely. Blue sky bio has a $15g printer now for in office use.