A healthy 42 year-old, new patient,arrived yesterday for a consult. In walks this issue (implant done 3 months ago and just loaded without socket augmentation). Pockets are 9mm+ at #9-distal and implant 10 medial and facial, linguals are more like 6-7mm. Exudate present. Taking out the implant will damage 9 further and 9 will likely be lost. Should we just extract 9 and keep 10 implant? Maybe it will serve as an overdenture abutment one day? Perio is advanced elsewhere. Or take out both and start over with ridge aug bone, PRF, and Tissue? Never seen anything like this… thanks for your input.
drtoast15 comments:Remove #9 and implant then get perio disease and any occlusal pathology stable before considering any tooth replacement
smartzookie comments:Sounds good but another Perio friend suggested it implant her removed it may leave a cleft through buccal to palatal… which would be a horrible defect to real with.
drtoast15 comments:I totally agree, but if you do nothing the same problem will occur, probably even worse.
smartzookie comments:Something will have to be done, that is for sure. I was interested in others' opinions as there is no simple or easy solution to this one. Thank you
timcarter comments:Remove #9 only as anything originating from its apex could easily mimic perimplantitis. I would remove #9 and place a cantilever provisional (a provisional is not the same as a "temporary") until I can get the generalized perio dz controlled prior to the likely removal of #8. IMHO it would be impatient and foolish to remove the fixture at this time.
smartzookie comments:The patient is currently undergoing periodontal disease control to retain the rest of his teeth before me make the ultimate treatment and restorative decisions. Thanks for you input
ninjadds1227 comments:With all due respect there is not enough information. Please submit FMX, CBCT cross sectional views of the implant and photos. The implant platform is at the apex of #9. This creates a very poor hygienic situation. Since you can only grow bone to the height of existing bone-the bone height you would want would be to the mesial of #9 and that cannot be done with this implant the way it's placed. What is the long term goal for the patient? If their entire dentition is terminal and you wish to edentulate and create an overdenture or fixed hybrid, what will new implant placement allow? Do you have 15mm of space for this new prosthesis? If you just remove 9 what do you want to place? Perhaps a crown on 7,8 with a cantilever? Once you touch this case you own it. You may be best served to refer to the person that placed the implant to see what their treatment plan was.
smartzookie comments:I have referred the patient back to the office where this implant was placed, he is not likely to return to this practice or this state as it is quite a distance away. I am not going to handle it directly but refer him to a more advanced reconstructive specialist, especially if he winds up with a cleft buccal-lingually.