Ailing Implant: Implant # 8 Site probes 7 mm and is bleeding, what should I do? How do I detox the implant for a grafting procedure?

Mon, 08/09/2010 - 12:11 — Dr. Barbie

What is the course of treatment these days for ailing/failing implants. If surgery and regrafting the way to go what is the best way to detox the implant to increase success.

Comments

Fri, 08/20/2010 - 08:35 — Tim Grant

Treatment of Ailing implant #8: Protocol

I would make a full thickness flap. Detox with a prophy jet and TCN. I would graft with a combination of FDBA and DFDBA and GEM 21.

Works well.

Sat, 08/21/2010 - 10:26 — Richard Hughes DDS

Tx of ailing implant

You may also consider taking the implant out of function. When placing the implant back into function, one has to correct all occlusal issues and my want to progressively load the implant.

Wed, 08/25/2010 - 07:09 — N Shumaker DDS MS

Failing Implant Tx (Not ailing!)

First let's get Dr. Meffert's terminology straight... Ailing implant means only soft tissue gingivitis around the implant. Failing means bone loss like peri-implantitis (periodontitis around an implant). Failed means mobility and hopeless prognosis.

The Number ONE cause of failing implants I see is CEMENT!!! There was a recent article in J Perio that found this as well. If an implant is deeply submerged I recommend the restorative doctor go with screw-retained b/c they can't get down there to clean the cement out.

If the cause is found to be inflammatory or occlusion then I agree remove the prostheses and place a coverscrew. I have seen better results in this type of case when I resubmerge the implant vs. leave it exposed and in function. Plus often times it's a good opportunity to redesign the occlusion on the restoration (often it's a 2nd molar restored with a huge occlusal table).

Detox of the surface is the biggest problem. I have used plastic tipped Cavitron, TCN, CHX, Prophy jet (very, very messy!!). Bottom line is none of them work very well. Looking at the studies on this there is no concensus at all as of today.

I think the future here may be use of a laser...anyone use one for implant detox and if so what type/wavelength?

Nick.

Wed, 08/25/2010 - 17:43 — HerndonDDS

Detox with laser

Nick... The issue with a laser for this would be antimicrobial effects with laser light interaction, sufficient scatter to enter microenvironments, (and/or energy given off by disintegration of water molecules such as with a Biolase). Millennium
periolase has scatter and reflection, no absorption by water, and thus better penetration into surrounding tissues, little of this with the Biolase because it is precisely the high water absorption that disintegrates the water molecules. Kill of microorganisms by light and/or physical means (water explosions) might be possible. Each of these companies claim success in decontamination (they use the term sterilization) by these methods. A diode laser would be questionable for this although there are those that claim you could be a magician with your diode. You know the routine. There are those that claim that one can detox an implant without flap with the Periolase, x-rays that show some remineralization of surrounding radiolucent tissues surrounding the implant. I would not be surprised if Biolase has some of these as well. The question is the predictability, but that is the question with any technique for detox, right?

I do think that there is merit in the concepts but I use a laser in combination with other techniques like what you mentioned. As with any attempt at detox, I have had excellent results and some that were less than desired. I have also treated these in years past with removal of surface microenvironments with finishing burs to a fine surface, reduced tissue such as with osseous surgery, corrected any occlusal interferences, and retained "high water" implants for many years in non esthetic areas on older patients that would refuse further implant treatment or augmentation. Of course, these were in the days of press-fit implants such as IMZ and others. I have also treated exposed Endopore implants that have become exposed. It was my thought that with the way they are made, removal of the surface treatment and balls made the most sense for the "pores" would be almost impossible to detox.

Just some thoughts..

Michael

Thu, 08/26/2010 - 05:46 — Richard Hughes DDS

tx of ailing implant

To add to my comment. I would flap if necessary and detox with burs and chemical agents.

Fri, 08/27/2010 - 08:16 — Mike Hollister DMD

Ailing/Failing implants: Great info.

Great comments from above...lets keep this dialogue going as this is a very tough area in practice to handle.

Here is a couple of nice articles in my files.

http://onlinelibrary.wiley.com/doi/10.1111/j.1834-7819.2008.00041.x/abst...

http://www.ncbi.nlm.nih.gov/pubmed/12898715

Sun, 08/29/2010 - 19:00 — Gregori M Kurtz...

Ailing vs failing

Ailing is defined as soft and or hard tissue loss without mobility of the implant. If any mobility is present then it is a failing implant and tx wont reverse that. With an ailing implant treatment can arrest the process and allow the implant to remain in function. One problem is often practitioners take a wait and see attitude when they see soft or hard tissue loss instead of trying to stop the progression.

Mon, 08/30/2010 - 13:39 — Laser Regeneration

LANAP on failing implants

I have several cases that have had good results with LANAP on Ailing implants. I don't know how to post pics on this site but here is a video showing a case

http://www.youtube.com/watch?v=11EM0mWedPo