What could have caused this bone loss?

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Brett Hansen CDT

Brett Hansen CDT

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First photo shows our screw retained variobase at delivery 2/11/22

Second photo is from last week. Patient has a pocket on the mesial that bleeds when probed
 

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modbl

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I wouldn't doom the implant yet just from these images. Check that the screw is completely torqued right now. Abutment might have got caught up on the close distal tissue at delivery. Bone doesn't like movement. Also tough path of insertion for a screw-retained crown. Wouldn't be surprised if there's light contacts trapping food. A cement-retained crown over a custom abutment might be nicer to the contacts.
 
doug

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A lot of variables going on. Does the patient smoke? Did the patient lie to the surgeon and told them they quit and didn't? Was it ok'd for restoration too soon. None of what you did is responsible for this outcome. Unfortunately, you are on the hook for everything you did, and that sucks.
 
Brett Hansen CDT

Brett Hansen CDT

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A lot of variables going on. Does the patient smoke? Did the patient lie to the surgeon and told them they quit and didn't? Was it ok'd for restoration too soon. None of what you did is responsible for this outcome. Unfortunately, you are on the hook for everything you did, and that sucks.
Doc isn't blaming me. They say a prosthodontist who looked at this case says they see it a lot with Variobase restorations. I do a lot of implant work. This is the first time seeing anything like this on one of our restorations. I prefer to not use Straumann's variobase, but this doctor insists on Straumann parts. I prefer to use a custom abutment(usually Atlantis).
 
TheLabGuy

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What bone loss? The angle of the PA was different from the first one is all I'm seeing. Matter of fact looks like you have more cortical bone attachment on distal now than you did before using Car 54s side by side pics. Patient clearly had an issue before...hygiene issue.
 
Brett Hansen CDT

Brett Hansen CDT

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What bone loss? The angle of the PA was different from the first one is all I'm seeing. Matter of fact looks like you have more cortical bone attachment on distal now than you did before using Car 54s side by side pics. Patient clearly had an issue before...hygiene issue.
Doc says implant is not mobile. That void area on the mesial in the first photo doesn't look like it should. I agree that there was something going on before the case ever came through our lab. The doc is worried that the variobase is causing the issue. I feel like I would have seen this a lot more by now if it was an issue with the abutment design causing the bone to resorb as the prosthondontist told her.
 
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its not the vario base we do heaps of them .i would say just reduce the contour in that area. sometimes you have to slim these ti bases down a bit to get the right shape for each job.
 
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MasterCeramist

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That’s a tough insertion angle which looks like it is leaving a pin point contact on mesial. If dr decides to remake the crown I would ask him to try and parallel adjacent contacts to get a broader contact and maybe go with a custom abutment.
 
Sda36

Sda36

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First photo shows our screw retained variobase at delivery 2/11/22

Second photo is from last week. Patient has a pocket on the mesial that bleeds when probed
Just another horrid placement, anyone see why this could not be corrected vertically and still in the Same bone mass. I had a case today, Straumann RN Synocta placements for a 3.5, 3.6. both flared well out of buccal corridor and not simply placed "on the ridge" which would achieve maximum bone density. These were buccal and tilted wildly, wth??? Would not ever have impacted mandibular nerve yet ?BangheadDontknow
 
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Excessive occlusal force begins to generate bone loss, this is a vertical loss defect, and more so because it sits on one side of the implant, the doctor has to use a periodontal probe and see the depth and check for bleeding…. , normally this kind of defect increases over time. , implants bone loss in a healthy patient is about 0,1 mm per year.
 
Brett Hansen CDT

Brett Hansen CDT

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Excessive occlusal force begins to generate bone loss, this is a vertical loss defect, and more so because it sits on one side of the implant, the doctor has to use a periodontal probe and see the depth and check for bleeding…. , normally this kind of defect increases over time. , implants bone loss in a healthy patient is about 0,1 mm per year.
Luckily, you can see that pocket was there the day my restoration was delivered :)
 
bigj1972

bigj1972

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Yeah, isn't there a doctor or surgeon around that's supposed to figure this sh*t out????
I mean that was the justification for $1000/ hr labor.wasn't it?
 
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