I have a colleague who sent this case to restore the two newly placed maxillary implants shown in the attached x-ray. I noticed that the head of the implant in No. 13 is exposed through the gums. My question: Can this be corrected predictably with soft and hard tissue augmentation, or would it be best to ask my colleague to consider removal and replacement at the crestal bone level – prior to restoration. Note – the lower abutment will be restored with FPD and implant supported as well.
Thanks for your opinions! They are always incredibly appreciated.
Dr. J comments:
Well, if you ask about predictability, the answer is no. Never in a million years would I implant what appears to be a very shallow implant placement. It would be great to see a periapical x-ray, but my recommendation at this point would be to remove the implant and place a new abutment in a good prosthetic position.
Guest Comments:
Not just great, but necessary to see the whole picture😉
AJ comments:
Is there something wrong with your eye?
Dennis Flanagan DDS MSc comments:
Have a conversation with pt. Risks for perimycitis or periimplantitis, bone loss should be assessed. Let the pt make the decision and document everything. You don’t want the pt coming back to you without adequate notes to show that the clinical decision actually affected the pt. I probably wouldn’t do a soft tissue graft because that would create a deep pocket. The issue of hygiene and rough implant surface is the issue. You may consider a bone graft.
AJ comments:
Why discuss with the patient? Isn’t the patient the one placing an implant there? The patient won’t tell you how to do your job?
Guest Comments:
Presumably to avoid a malpractice suit, it is the patient’s body. Also, getting permission from the patient to cover a misplaced implant won’t get you off the hook. 😉
AJ comments:
Then why should I ask permission to let you off the hook?
Bill McFatter comments:
if you bring it back you bought the problem You knew or should have known there was a problem and you didn’t discuss it with the patient before they spent their money on this review
Guest Comments:
The x-ray posted is insufficient to make a diagnosis, it appears that there is another molecular implant that is too deep. First I’ll repost movies showing the full implants and then ask for advice. I don’t understand why the pre-op films are included. You could just send the patient back to the dentist for correction. It’s not your problem.
Guest Comments:
What did the placing dentist say about this case? Just curious.
Steingrimur Hermannsson comments:
I had referred this patient to the placement dentist for a possible sinus lift and implant placement at No. 14. However, the placement dentist decided to extract and replace 13 and 15 with implants. This is the result we have now. I am concerned about future threading and peri-implantitis without adequate correction. Thank you all for your thoughtful advice. It is highly appreciated.
AJ comments:
Raffle!! That’s the problem!!!??? yes sinus lift before implant!
Guest Comments:
I think you lost control of the case. Both implants appear to be poorly positioned and if not addressed now the restorative will be compromised. One implant too shallow the other seems too deep. I would tell the fitting dentist that this case cannot be restored, give the patient a refund and find someone to work with you. Placing the implants at 13.15 is good to avoid sinus lift, but the two implants cannot be restored. There are exfoliation kits out there. The sites can still be used. When the implants fail, you will be thrown under the bus.
Guest Comments:
Love OsseoNews, implant placement “Sports Page”
Richard Winter comments:
Since this information is insufficient to make an informed opinion, we can discuss prosthetic space or CHS. Since the microfilaments hold the tissue hemidesmosomes, it is possible to make an abutment, profile the bone on the posterior implant and fabricate a prosthesis. You cannot predictably grow the bone 360 to cover these threads. You can mill the threads and cover them with your bridge if needed. Good luck and if there is not enough CHS then the implant may need to be implanted. Again, all theoretical as this is not even close to the information, x-rays, photos, cbct needed to make an informed decision.
Timothy Carter comments:
My recommendation would be to restore the implant that the patient paid for and tell them that it may not be the most esthetic case, but it should provide many years of service. I’m glad I’m not a patient relying on some of these super complicated solutions for simple imperfections that many here are suggesting.
Mahijeet Singh Puri comments:
Do the opg first as there seems to be another implant that is submerged. Bay floor lift done too Let me have a look at the last opg and only then can I comment
Manosteel Manosteel reviews:
Why didn’t the placement dentist place the implant deeper?? Even a bay lift with hydraulic lift would work for a 4-5mm gain. At this point I would get someone else to place them or learn to do it yourself from Misch or Louis AlFaraje (California Implant Institute). This implant can be used if it is not a cosmetic problem and you have a minimum of 10mm of implant in the bone. Use a collar polish on any supragingival implant surface, then place a crown or bridge on #15. Don’t let a periodontist or medical doctor decide your restoration plan, if you don’t know, send it to someone who does Prosthodontics.
Greg Kammeyer, DDS, MS comments:
Bone growth around the implant head is possible but not as predictable. I would advise the patient that it’s not my “best work” and I’d rather do it again (a recommendation that would stand up to legal scrutiny.) If the patient refuses, don’t peel, sand, and polish the rough surface. This will help keep you from getting peri-implantitis. Do not restore it “as is”.
