Originally Posted by Bryanna

Hi cyn,

Thanks for posting the xrays. The bone surrounding the actual implants looks ok on these films, but it does not give any clue as to the buccal portion of the bone which is the front of the bone facing the lip. This area is crucial for the retention of the implants. Is either implant loose? There is quite a bit of generalized bone loss interproximally, in between, the adjacent teeth on both sides of the implants. Did you or do you have periodontal disease? Did you have bone loss or deep pocketing on your lower teeth prior to or after the ortho... or the implants?

There are a number of reasons why this problem has occurred and most likely, it is a combination of things. As I originally said, placing implants in this lower portion of your jaw after congenitally missing 24 and 25 was a risky option and you should have been fully informed of that at the onset. if you had any perio disease, previously diagnosed or not, you should have been informed about it as well as the risks during the treatment plan phase and prior to doing the ortho. Has the dentist measured the pocket depths in your lower gums since all of this happened?

The only way to cover up the portion of the metal implant that is showing would be to redo that implant crown which would make that tooth quite a bit larger than any of the others. However, if the gum tissue is receding because of a disease process, perio or other, then making a bigger crown will not solve the problem because it will just continue to recede.

From my experience, the most significant issue here is the bacteria that is getting in that open gum tissue and down inside the bone along the implant. This area has got to be really difficult to clean and the gum tissue looks so friable, meaning irritated/inflamed/fragile.

Even if your body is to blame for the rejection of the grafting... that issue should not be ignored by your dentist and she should be offering you every thing possible to remedy this situation, including a referral to someone else, and a reimbursement of at least a portion of the fee for the grafting.

Generally, oral grafting is rejected by the immune system because there are certain factors that caused this to happen. It could be an <undiagnosed> autoimmune disease... periodontal disease...certain medications that inhibit wound healing...lifestyle habits such as smoking, excessive alcohol consumption, poor oral hygiene or even the use of mouthwash containing alcohol.....and the list goes on. Other reasons the graft would fail are due to the actual dental procedure and/or graft material itself. If during the procedure the surgical area or the graft material was not sterile....if there was contamination with your own saliva....if it was not placed properly... if it was disturbed before the clot was able to protect it and nourish it.... and this list of reasons goes on too.

It will be hard to find a dentist who is willing to redo this because the area has been surgerized alot which makes additional surgery risky. Also, because of all the previous circumstances, esthetics to your liking may be difficult to achieve.

I may have asked you this already. Have you consulted with a periodontist?

Bryanna