Unusual bone loss around implant: suggestions?

Patient complains of sore gums around implant. I found an isolated 7 mm PD on the distal but everywhere else was firm and probed 3 mm or less. Radiograph shows radiolucency around middle of implant. Any suggestions on treatment or ideas on what could cause this type of bone loss?

drtoast15 comments:

Buccal or lingual fenestration

drnewitt comments:

Did you palpate the submandibular fossa?

timcarter comments:

The fact that you are probing 7+ on the distal is consistent with the image and I suspect that with a little more effort and a different angle you will find the same on the mesial. It is interesting how our eyes will pay tricks on us because realizing that this patient clearly has a thick lingual/buccal cortex (evident by the radiopacity) it is clear that this is just a typical implant failure with really no unique features. I would suggest not placing fixtures this far posterior as it is on the ascending ramus and likely does little to improve this patients function anyway.

richardw comments:

Good placement with no bone less. Because of the distal tipping of the implant and the wide crown, I would suggest that the 7mm picket, is partially a pseudo pocket. You did not mention any lack of attached gingiva, bleeding nor describe the pain that the patient is feeling. From the opposing crown position the pain could be occlusal in nature. Is there any anterior guidance. Does the patient have a dual bite slide from cr to co? Class 2 bites tend to be llikevthis and put too much pressure on the last molar being used for guidance if the cuspids don't engage when in a distal position for swallowing.

gregkammeyer comments:

I agree with Tim. You probably hit an area where a small localized residual NICO lesion was present. Back it out, curette and aggressively run a #8 round burr in the socket to be sure you got all the diseased bone, socket bone regeneration and wait 4 months. In my experience, patients that are fully dentate except for one loss second molar appreciate it's replacement.