Bone loss implants 6,7, and 8?

66 year old female had implants #6, #7 and #8 placed elsewhere after alveolar bone grafting. Patient now presents with esthetic problems with threads exposed, recurrent infections and food trapping. See enclosed image. I don't feel that these implants can be salvaged with grafting procedures. Suggestions? Thanks. LG

Charles comments:

Wow, quite a mess - poor patient - so much pathology and too many factors to consider before any feasible suggestions can be put forward. Will keenly follow thread on this one (hope a very competent specialist will advise/treat/oversee Rx) All the best

Dale Gerke-Prosthodontist comments:

Although it is unwise to diagnose from the scan provided, it does seem that there are multiple problems. My suggestion is that you start with the basics, ie explain the multiple problems and the consequences of what will happen if they are not fixed. At 66 years old, the solutions do not have to be quite as substantial compared to if the patient was 30. Nevertheless issues need to be addressed and a proper and adequate treatment plan created. You would then be wise to ask the patient what she wants, ie does she actually want to restore her teeth, gums and sort out the implants? What are her expectations and desires? Your treatment then depends on her answer. I suspect her answer might be influenced by cost and practicality. The important thing is for you not to just aim to fix the implant issues because it seems very likely most of those specific problems are occurring because of the other problems in her mouth.

Dr Dale Gerke – BDS, BScDent(Hons), PhD, MDS, FRACDS, MRACDS(Pros)

Sumit goel comments:

Hii recurrent infections reason should be identified.. exposed threads and food entrapment could be one reason.
  1. So if u carefully do some soft tissue grafts ( FGG) and modify embrassures- plaque and food trappment would be minimized… offcourse all this to be done along with curattage and disinfection arround implants, occlusal refinement…

  2. if pt not willing for FGG. simply open flap … smoothen exposed threads with bur…curattage…disinfect…place healing cap… and suture it… after 10-15 days u will see exposed threads covered by tissue … designing of occlusion with same/ new Prosthesis having maintainable embrassures…

Frederick comments:

Need a CBCT. But they look like losers.

Main issue is posterior collapse LL.
This must be addressed with implants as well.

Use 8, 9 for provisional anterior. Remove and graft 6. Wait 6-9 months place implants 6, 11, 12 wait 3 months provisionalize 6-12 extract 10 remove or sleep 8,9, Wait 6 weeks for final impression.

Jeffrey Backer, DDS comments:

Too often dentists are afflicted with tunnel vision we need to take a global view 1st for instance; # 17 Has periapical pathology (universal numbering system) #18 has extensive distal decay, #5 has distal decay #15 has decay. Also regarding these implants when were they placed? Is this what they look like after 2-3 yrs in the mouth or after 15-20 yrs? When I get cases from other dentists I will routinely reach out and ask for xrays and notes so I can evaluate how fast the breakdown is occurring. Photos are a great help High or low smile line? If the pt is hiking her lip up over her nose with a mirror 2" away, refer! What is the "driving" problem here? That over rides the other issues? If you put finger pressure on the tissue is there purulence? Also wondering about radiopacities #23 & 27 areas. Good luck.