What do you recommend?

[Boise Dentist]

hey, implant may not integrate with your bone.

 

[Brett Hansen CDT]

The implant is osseointegrated and shows no mobility.

The doctor spoke with the patient about our proposed plan of adjusting the implant and abutment so we could cover up the exposed implant. I received the impression yesterday. The pics of the model are attached. This is a Nobel Replace implant. I don't think I can adjust much off the facial of the implant because I will get into one of the lobes inside the implant. I am assuming that would definitely be something I should avoid. What do you recommend now? Can the doctor prep slightly into the abutment channel on the implant as long as he doesn't get into the screw? He knows these recommendations are risky and he is not happy with his work on this case, but he just wants to try and get the best possible outcome for the patient at this point.

 

[Labwa]

What about pink zirpress onto the abutment extending past the implant fixture. It's by no means perfect but i think that might be the best solution.

 

[Brett Hansen CDT]

Labwa, we are definitely going to add pink porcelain past the abutment-implant interface...I am trying to minimize the gap that is going to behind the restoration as much as possible. The more I can adjust the facial of the implant, the smaller this gap will be. I am trying to figure out what a "safe" amount of reduction on this implant would be.

 

[2thm8kr]

I would suggest staying away from the lobe interphase of the implant. We have had those tri-lobes implants
split in the mouth making in a problem torquing the screw and keeping the abutment tight. Implants are still
there, but the clinician is married to the case constantly removing the crown to retorque the case.
I would use this situation to express the importance of diagnostic wax ups and surgical guides with
the clinician to build a better relationship and avoid these situations in the future.

 

[2thm8kr]

What about pink zirpress onto the abutment extending past the implant fixture. It's by no means perfect but i think that might be the best solution.

This might be your best bet, since a good portion of the buccal plate is gone. A Zr abutment with emax gingival Zirpress ingot pressed to it
to replace the soft tissue area. E.max crown over the top.

 

[Brett Hansen CDT]

I had an old Nobel UCLA abutment laying around, so I inserted into the analog and started reducing the facial of the abutment and analog. I didn't reduce into the facial lobe on the interior of the implant analog. I stopped reducing when I got close to the screw head. There is still a substantial piece of the implant that is sticking above the tissue below where I prepped. Also, the implant is supragingival on the mesial and distal. I called the doctor and I am sending the whole model with the abutment back to him so he can decide what to do. He may decide to try some more grafting. I go on vacation in 7 days....I am really glad this case is not in my lab right now.

 

[rmcmanus]

The implant is simply placed too far buccally for any grafting to succeed. Even if you could restore it; eventually the buccal tissue would receed leaving a miserable result. The implant needs to be removed and done so that this patient can have the success that is achieved but only when a proper treatment plan is done before the surgery. The general dentist surely does not know how to do this and the surgeon didn't either or was too lazy to do a surgical guide for this patient. I would mail the case back to the dentist and suggest he learn how to treatment plan implant placment or sent the presurgery case to you so you can make a radiographic/surgical guide( if you know how to?)
Richard McManus, DMD.

 

[CaptainInsano25]

Just screw it in a little deeper

That's what she said.

 

[corona]

brett, this is everything that could go wrong . decline this one . How can you restore this situation ? The buccal plate looks so thin or the implant is so close to it that i fear the bone is just going to keep on losing its integrity and finally the implant will fail . I know we want to try and salvage the day but this is way beyond what materials can fix. Id go with rmcmanus suggestion for the patients sake . Get that implant out of there , repack , let it heal , then use a surgical guide for petes sake when replanting and avoid that nonsense. This is going to be an expensive lesson for the doc.and or surgeon. Right now this has only cost you the model work and some time . We get tough cases all the time but this one is way way out there . lets all hope the patient will be forgiving . good luck .

 

[GeneNY]

How about a pink removable flexite gasket?

 

[Brett Hansen CDT]

This implant was placed by the GP. He is a real nice guy and has been an account of ours for a very long time. I sent the case back to him yesterday. I am hoping he comes to the conclusion that you guys have stated...remove the implant and try again. Personally, I feel like the implant he used is too big. I appreciate the input.

Gene, I thought about your idea, but one of the main benefits of getting an implant is that it is fixed.

 

[lcmlabforum]

Well, none of us know the history, and the 3-D anatomy limitations. Sometimes, the ridge is undercut and slopped,
and the patient really wants an implant because #8 may be non-restorable at this time. Not trying to defend
the DDS, but we do not have the big picture and hx to knock on the case. Just my 2 cents' worth.
LCM

 

[lcmlabforum]

BTW - if the DDS decides to better remove and replace, I strongly suggest referring
to a good oral/perio surgeon. If you do not place enough of a block graft, I doubt that
you would get a good outcome as far as where the implant platfom would end up
for the ideal gingival transition where the crown starts.
There is a good chance that the patient never had enough bone in the first place.
Removing the implant(s) would likely result in greater bone loss and and even greater
esthetic compromise. Would be a great teaching case for his study club . . .
LCM

 

[Brett Hansen CDT]

I appreciate all the input guys. As i stated previously, I sent the case back to the DDS. He is gonna talk with a perio friend of his about what to do next. I don't have the heart to tell him that he should remove that implant. I am hoping the periodontist will tell him that. We can't do anything with it as it is now.

 

[rkm rdt]

I bet they just leave things the way they are and let you do your best without trying to cover the implant.

If the pt has a minimal high lip line then they may be happy just having a tooth there.