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FAQ:  Implants

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Dental Implants Ask The Periodontist Edward Brant Question:
I have an implant that is 10 years old but due to complications after replacing the crown (1 year ago) I am now stuck with a flipper and a very large space instead of a front tooth.

Is it possible to do a ridge augmentation or bone graft without removing the implant I still have? ... Visitor from NY

I am going to have to make several assumptions to answer this question.

In most cases, in order to significantly improve the soft tissue and hard tissue anatomy, the previous implant needs to be removed.

Retention of the implant almost always provides a source of contamination and compromises the blood supply to a new ridge augmentation surgical area. Besides, new bone and soft tissue does not predictably reattach to a an "old implant."

If all you need is more soft tissue to improve the appearance, then a consideration can be given to retaining the original implant fixture. Soft tissue ridge augmentation is more forgiving in this instance.

However, if you have a "very big space," this is likely caused by a loss of hard and soft tissue volume. I am worried that the bony support for the implant is compromised beyond the point of repair. Somebody needs to give you information on the health of the bony support.

My guess is that there has been a loss of bony support because of the "big space" you complained about. There needs to be an adequate amount of bone to support the gum tissue. The gum naturally shrinks away when the underlying bone shrinks away. Based on your description.

In order to restore the area to proper function and esthetics, it sounds like removal of the implant fixture with subsequent grafting is the most predictable treatment.

Removal of the fixture needs to be done with care not to remove excess amounts of bone. The instrument which has worked well for me is called a Piezosurgery unit. This instrument vibrates a thin layer of supporting bone away from the implant fixture which allows for the least amount of trauma during the extraction of the implant body. This results in less post-op discomfort for the patient.

Additionally, this instrument conserves bone which reduces the quantity of new bone which needs to be regenerated for the future implant. My advice is to seek someone out with this instrument and shy away from a practitioner who uses drills or trephines (little hole saws) to remove the implant.

Edward Brant, DDS, MS
Reconstructive Periodontist
447 Lake Avenue
St James, NY 11780
(631) 584-4395

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