Dental Veneers after failed dental implant
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.
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.
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
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.
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.
You’ve made quite a few negative assumptions about “most dentists”; I’m curious what dental school you went to. Care to share?
Hes telling the truth it happens all the time. Money hungry dentist who dont care, example dr. Connly in st John’s michigan has royalty screwed up my mouth. I didnt have enough bone for 3.5 in front and he buried my implant deeper in my gum to hide it with a srew he buried my implant under my skin with a srew. I’m in severe pain now.