Prosthodontic Solutions

It's not supposed to rotate like that is it???

A case I dealt with in 2014. This patient was referred to me due to a 'loose implant crown.' Unfortunately, it as the implant itself that was mobile. The implant and veneers where completed about 10 months prior in Texas. That dentist reported to me that 'the implant was well integrated' when he last saw the patient. I did not receive a specific diagnostic reason why tooth #9 was lost other than 'it was broken and they recommended an implant.'

The treatment plan the patient received their was one that did not address the major etiologic factors. In fact, it appears to have increased the patients risks. Specifically: untreated malocclusion, grafted implant site, and maxillary bone. The 'graft' particulate can be seen on threads of the explanted fixture. So while a dental implant may have been a reasonable choice for this situation, it was not the fail-safe option the patient was led to believe.

Implants are less forgiving than natural teeth. Especially in the presence of significant malocclusions and heavy function patients. Conventional restorative therapy, even on debilitated teeth, is generally more predictable.

In conclusion, a conventional FPD was fabricated - after the patient again declined orthodontic therapy. It was cemented in 2015. He was turned over to his local general dentist at that time.

Today’s implant emergency…

Classic failure of a single tooth maxillary molar implant. This was placed in a grafted sinus, was the distal-most occlusal contact, and had a typically poor crown-implant length ratio.

Fortunately this one had been in function for over ten years. Evidently, even implants by experts fail as this was done by a prominent prosthodontist on the lecture circuit from down south. Surprisingly, the sub-gingival cement you see at the abutment margin did not appear to have caused significant supracrestal mucositis.

So much for ‘implants last a lifetime’

Michael P. Waliszewski DDS, MsD