Dental Implant Difficulties


In 2006, a male patient age 47 presented with a fractured tooth on his upper left first molar. I sent him to my surgeon who extracted the tooth, did some bone grafting to help with any bone defects, and later had a large size implant placed in the site. A few months later I restored it with a crown, and all seemed to be fine.

Four years later he appeared in my office saying that his implant fell out. This is usually a crown falling off of the implant, but in this case the implant had really fallen out. This is a most unusual situation.

I referred this patient back to the surgeon who prepared the site with bone grafting material, then later placed a new implant, and that was restored with a crown in early 2013. All seemed fine.

Today he came in for his cleaning and some hard tissue poking through the bone on the outside of the implant. The implant seems solid, and the bone around the implant seems fine and adequate on the x-ray. However, I suspect this is a sequestrum (dead piece of bone) working its way from the outside of the implant toward and outside the tissue. I have just referred him back to the surgeon for evaluation and treatment.

I suspect that the surgeon will perform a small surgical procedure where he will remove the dead bone. Once removed, he will evaluate the implant from the facial aspect from where the bone was removed, and see if the titanium is exposed. If so, he will try to graft some bone from the outside (after treating the implant with solutions) and then get the tissue to grow over the defect. It’s a bit complicated, but when dealing with implants, you have to be prepared to treat any difficulties which may arise. Since the implant is quite snug in the socket, I expect a successful outcome to this treatment.