Dear George

This is a terrible situation you are in. I can tell you it is not
supposed to turn out like this and for some reason something is not
compatable with you.
Bio-Oss is a matrix of cortical bone taken from a cow. It is possible
that within this bone mineral is hormones that were given to this cow
during its lifetime. Your body may not be compatible with this type of
bone graft although if you talk to the manufacturer of Bio-Oss they
will swear it is safe and can not be the problem. We really do not know
how much truth there is to this.
I've work with bio-oss all the time and I have to say it takes much
longer for this graft material to fuse with your own bone and having
good bleeding during placement helps. Some clinicians mix tetracycline
with the bio-oss to help with bacterial contamination which you can not
avoid in the mouth unlike heart or brain surgery. Others say adding
tetracycline make the site more acidic and it is not favourable to the
graft.
What I can tell you is this Biooss by itself in 6months still is
destinguishable from your own bone but is hard. Bio-oss with
tetracycline looks yellow with white particles both during placement
and at 6 months. Generally Bio-oss seems to stick around the site
longer than your own bone which would be the ideal choice of material
but will require a donor site surgery such as the chin area or back jaw
bone(ramus area).
If the implant is solid I do not recommend its removal. The surface of
it needs to be treated and a bone graft done again. Maybe the second
time around you should insist on using your own bone(autograft) vs from
a cow(bio-oss=xenograft) or from your dead neighbour(allograft). Freeze
dried bone no matter how well it is cleaned is not vascularized and
hence it is dependent on getting your own blood from surrounding bone
and sometimes taken from your vein centrifuged (PRP=Plasma Rich
Protiens) which helps in the grafts success. Having given you bone
grafting 102 course, you should also consider that either cement got
under the gums which caused this infection, or more likely the
infection is coming from a neighbouring tooth which abscessed sine it
was preppared for a bridge once and then once again for a single crown.
Best bet is to check the lateral incisor since it is a smaller tooth
and could be the culprit.
Do not get discouraged with implants it is still the best long term
alternative you just had a lot of bad luck.  And going back to a bridge
does not mean you can not encounter abscess of the adjacent teeth since
this would be the third time they would have to be preppared getting
smaller each time and the risk of them fracturing at the gum line
increases as well. Also do you happen to know the implant
manufacturer???

Sorry to hear about your problem with your implant.  As you know, NOTHING we
do in dentistry/medicine is risk free, and your story proves this important
point.  I can understand your frustration, but on the other hand, these type
of outcomes do occur, and quite often there is no cogent explanation for
them.

OK bear with me guys. This is a bit long as I try to provide a good
background to the problem.

I had a titanium implant installed 3 years ago in place of my missing
upper front tooth. I broke the tooth in a fall as a kid and
subsequently had the rest of it extracted in my teens when it got
infected. In place of it I previously had a bridge which was installed
about 10 years ago and before that I used a partial denture.

Anyway about 4 years ago (2002) I decided to 'upgrade' to an implant
and two adjacent crowns (for the 2 other teeth that made up the
bridge). Implant technology was sold to me by my dentist (who is an
implant specialist) like it was one of the easiest procedures in the
world, a cake walk. So I went for it without hesitation. Since then it
has been somewhat of a nightmare and lots of money wasted.

First off I needed 2 bone grafts because there wasn't enough bone
width in the area. I had 2 grafts because the 1st one (using a newly
introduced product that was supposed to be better) didn't work. The
dentist said it seems my body simply got rid of it. So he did the 2nd
graft with the old tried & tested Bio-Oss. After about 8 months of
allowing it to heal and set the dentist checked and said there was just
about enough bone width for the titanium implant. He installed the
implant and everything sailed OK from then on and about 10 months later
I had the crown put in place. So the whole procedure took almost 2
years before the crown was eventually installed on the implant!

Anyway I was happy to have my implant and crown at last and followed
all instructions diligently in terms if cleaning and getting dental
checkups every 3 months.  I don't smoke, take drugs or any
medications. I'm a healthy fit man in my early 30s.

I had the implant for about 2 years without any issues. Then about a
year ago I began to get a strong taste in mouth.  I later found out the
taste was from the gums around the front crown (the one with the
implant). When I rubbed the gum above the tooth my mouth would be
flooded with the unpleasant (sometimes salty) taste and it had an
unpleasant smell. Even after thoroughly brushing and flossing, when I
rubbed the gum area I got the bad taste and smell. Apart from that
everything seemed fine with the tooth. The gums around it looked
healthy, I felt no pain and the tooth wasn't loose. I went to the
dentist and he checked the implant by taking x-rays etc and said the
implant was fine. He gave me antibiotics for what he said was a gum
problem.

Fast forward a few weeks later, the antibiotics did not stop the bad
taste. I went back to my dentist several times but he insisted that
there was no problem with the implant. He would take x-rays of the
implant, examine the gums etc and always ends up saying everything is
fine with the implant and there is no infection.

About 4 months ago the situation got worse. At this point I was
resigned to the intermittent bad taste and thought maybe this is just
the side effect from having a titanium implant. Anyway as I was
brushing one morning I noticed a whitish/transparent liquid secreting
from between the gums and the implant crown. When I pressed on the gum
above, more of the liquid came out. It looked like puss and smelled bad
so I quickly visited the dentist again. This time he saw the liquid but
said it wasn't puss. He cleaned up the area and gave me stronger
antibiotics. However that didn't resolve the problem.

A few weeks later he opened up the area and thoroughly cleaned it up
and put more bone graft (Bio-Oss). He said he noticed a lot of bone
loss and a slight bone defect to the side but not directly in the area
of the implant. He said the implant wasn't exposed and there was no
infection in the area at all.

To cut the story short, all that didn't work. A few weeks later the
bad taste and secretion returned.

My dentist now agrees that the implant needs to be removed, however he
says the problem is not with the failure of the implant itself but
something to do with the bone graft that is not working with my body.
He said a lot of the bone that was generated from the bone graft (and
was there during the time he inserted the implant) has now turned to
soft tissue. I find this hard to believe. Can bone that has already
been generated turn back to soft tissue?

Throughout the time I was having bone grafts, before the implant was
inserted, I never once noticed a bad taste or smell coming from my
gums, even when the first bone graft failed. So I find it had to
believe that my body's rejection of the bone graft material is what
is causing the problem here.

My dentist doesn't seem to know quite what has gone wrong, although
we both agree that the implant needs to be removed because there is
obviously something wrong. I have made an appointment in month's time
to remove the implant. My dentist warns me that it would result in a
massive bone defect in the area as the bone would collapse inwards
after the implant has been removed.

I was thinking about getting a 2nd opinion before proceeding but I'm
not sure what another dentist can tell me without access to the full
records of my implant work. Consultations for implants are quite
expensive here in the UK. I don't want to pay a lot of money for a
consultation only to be told I have to go back to my dentist for a
proper assessment of the problem

Right now I don't know if this bad taste in my mouth and what I can
smell when I rub the gum around the tooth is giving me bad breath. It
is causing me a lot of stress and wreaking havoc on my social life.

I feel deflated. I can't believe I spent up to £5,000 on this
treatment that was supposed to be the best option out there only to be
left with this stress, fear of bad breath and now being told that
I'll have to go back to a denture after the implant is removed. Going
back to the bridge like what I had before is not even an option now
because the two adjacent crowns have been hard cemented with crowns.
The crowns would have to be cut to fit a bridge and my dentist said
that could damage those teeth.

Has anyone had a similar experience with dental implants? What was the
outcome in your case?

Can anyone shed any light on my situation from reading my case, i.e.
from past experience or knowledge in this subject matter?

Any tips/advice/information will be very much appreciated.

Thanks

George

First off, I am so sorry to hear of your problems. I am not a dentist,
I just come here for information, as I am currently in the process of
getting SEVEN implants! I hope to goodness, I have no such problems as
your's. Fortunately, I do not need any bone grafting, only a sinus
lift, which is giving me some concern.

Secondly, thanks so much for Dr. Vasserman for providing us patients
here with such good informatin re implants and other things!

Now, as I said, I am not a dentist. But as a fellow patient, I would
strongly urge you to get a SECOND OPINION. I think you should be up
front with your oral surgeon, tell him you have been advised to get a
2nd opinion, and that you would like to take the xrays etc. to another
oral surgeon.

Then, do whatever it takes to make SURE the guy you go to for the 2nd
opinion is among the top in the field. Not sure how to find out, maybe
ask at the nearest dental/oral surgery school. Find out who
specializes in implants and ask around who is the best. Then go to him
and explain everything, show all the xrays and get his opinion as to
how to proceed.

I understand that money is an issue. However, this is your LIFE. Beg,
borrow, or steal the money to get this 2nd opinion and beg borrow or
steal the money to get whatever treatment this 2nd oral surgeon says
you need.

I have no way of knowing if the first guy is good or not. He may be
great. However, I do know that Human Nature is that IF he made a
mistake, he is not likely to admit it. That's why you need a 2nd
opinion. Also, if he does not really know how to proceed, he may be
the type to guess rather than to ask for help.

So as a patient who has had much bad dentistry in the past, I strongly
advise you to get a GOOD 2nd OPINION!

Good luck! I'll send positive energy your way.

Yes, I'm afraid so, although my two implants (front teeth) failed after
eight years despite having excellent oral hygience before and after the
placement, and even though I'm a youngish non-smoker, moderate drinker
and otherwise in good health. Three specialists have been unable to
provide a good explanation as to why this should have happened.

The problems started as a slight swelling under the gum (no bad taste
though), which was diagnosed as being due to a defect in the bone
around one of the implants. The defect was initially treated with
Bio-Oss, but that actually didn't solve the problem at all. In fact, it
seemed to accelerate things, as within two or three months more bone
was lost and both the implants became loose necessitating their
removal.

Of course, that left an even larger defect which needed a bone graft
(taken from my hip) before an attempt could be made to replace the
implants. A bridge is not a consideration for me as all the adjacent
teeth are intact (no crowns or even fillings) and I'm not prepared to
damage those for the sake of two missing teeth. The bone grafting
procedure wasn't too bad at all - it was almost painless where the bone
was placed in the jaw, and there was only moderate discomfort in the
hip area for about a month afterwards.

However, the complication was a lack of gum tissue to stretch over the
newly-placed bone, because this had obviously shrunk where the original
bone was lost. Although the surgeon initially managed to get coverage
of the graft, this shrank back after about a week to leave a nice area
of exposed bone. Six months later, new gum has actually grown back over
most of this area, although there's still a couple of small spots that
are still not completely covered. Although some of the graft has
resorped and small bits have flaked-off over time, it otherwise seems
to have taken which is apparently a bit unusual according to my
surgeon. My whole case appears to be less than routine though, so
perhaps this is only to be expected!

The next stage is to try and place the implants and see if they work
after all the recent fun and games. There seems to be a bit of
uncertainty about the chances of success after prolonged exposure of
the graft, although the remaining bone seems healthy with a decent
blood supply.

BTW - GBP 5K seems a lot to pay for a single implant in the UK.