AboutJoel S. Teig, DMD, FABOMS Expertise I am a board certified oral and maxillofacial surgeon and I am available to answer questions related to tooth extractions, implant insertion, facial recontruction, facial and oral tumor removal, TMJ dysfunction and various successful treatments, including surgery if all else fails, and occlusal discrepancy requiring orthognathic or jaw surgery.
Experience Board Certified Oral and Maxillofacial Surgeon practicine for over 20 years. Assistant Clincal Professor and State University School of Dentistry.
Organizations American Dental Association, American Association of Oral and Maxillofacial Surgeons, American Board of Oral and Maxillofacial Surgeons
Education/Credentials BA
DMD
Awards and Honors National Honor Society (OKU), Philadelphia County Dental Society, Mosby Book Award, Oral Surgery Honors, Summa Cum Laude
Six months ago I had inserted few Zimmer implants: ##28, 29 and 30 on right side; had pain and swelling for quite a long time after insertion (specifically #28) and wanted to remove that implant. You opined that because I started to feel better was a good sign, so I should not prematurely remove it unless the pain increases again. You also suggested that the implant stay a full 6 months before uncovering before the bone completely heals (that takes 6 months).
But unlike ##29 and 30, #28 (13 mm) was never covered as the gum failed to heal above it and all 6 months it was above the gum. In fact, the dentist told me that even though it was fully turned into the bone, it went up a couple mm. (and so the black area under it's bottom explains this phenomena). Right now I don't feel anything wrong with it, it is stable, don't hurt, but it is not loaded.
My dentist said that X-ray of #28 is less than perfect; it passed the rotation test (the key “broke”), but he is not too eager to connect ## 29 and 30 with #28 via a bridge. In fact, he offers to remove that implant, to wait two months and put a new one, even before it would possibly fail. He also says that the fact it went up couple mm would be a cause for future bone loss at this implant. What you can suggest on this situation? May I e-mail you X-rays to look at?
Thank you very much for your expert opinion!
Respectfully, Vlad
ANSWER: Vlad - Similar to your dentist, I feel a little uncomfortable with your implant that has that black area. The good point is that you are not uncomfortable. Once an implant has not truly integrated to the bone surrounding it is stressed with usage in a bridge, it will often begin to develop symptoms and an appearance of failure. The one thing your dentist says that I disagree with, is that if the implant is removed, you need to wait a minimum of 4 months to allow complete bone formation to insert an implant. Premature placement will often not allow for a healthy implant.
I am a "belt and suspender" surgeon who believes that complete healing is the only way to proceed and use the implant. Send me a copy of the xray to review: tigertooand2@yahoo.com
I'll look at the film and get back to you and give you advice.
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QUESTION: Dear Dr. Teig,
On July 3 I've sent you two e-mails, one with 6-months, and another with 4-months X-rays, to the address you indicated (tigertooand2@yahoo.com). If you did not get them I can re-send those X-rays.
Respectfully, Vlad
Answer Vlad - If the implants were inserted just a couple of months ago, that dark area at the end of the implant would mean an area that is forming bone. Now, six months later, you most likely have fibrous tissue formation there with less density than bone. With the fact that the implant is asymptomatic and you have no discomfort when they test the implant, the area in bone may just be scar formation. That occurs, but if you had symptoms and drainage at the implant in the mouth, that site would be infection.
The fact that it appears fairly normal would most likely not condemn it in my mind. It could probably be used. The fact that it is not fully covered may indicate that there might have been a surface infection originally that produced your symptoms, but with no present signs or symptoms of a problem, it has most likely healed.
