Perio breakdown, occlusion or Prosthetic miscalculation?

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Posted on By Maurice Salama In Failures

Patient presents for routine hygiene over past 3 years with issues on Lower implant supported bridge distal implant abutment. Take a close look and tell me your thoughts? Is this classic perio breakdown that went untreated or is there something else that may have caused this to occur? Treatment options?

2015 PA
2016 PA

2017 PA
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Dear Maurice, Question:
1. Are splinted implants, right?
2. Are internal hexagon, right?
3. Are screw retained bridge, right?
3. Are UCLA the last abutment, fused, right?

I think the problem must be NO PASSIVITY in the structure to implants...


1. Are splinted implants, right? YES
2. Are internal hexagon, right? YES
3. Are screw retained bridge, right? Distal implant screw retained, all others cemented.
3. Are UCLA the last abutment, fused, right? Not sure, do not think so.


Dr. Salama, What would be the best prevention of that? Splinting screw retained abutments 2 and 2 instead of 4 together?... Having 3 implant bridge instead of 4? Please explain. Thank you.


Dr Salama,

When were these implants placed?
Was any tx for peri-implantitis provided in 2016 or before that?
I have heard in Dr Renvert's lectures and have also personally witnessed the radiographic presentation of the defect to be different between plaque induced and occlusion induced lesions. Plaque induced usually shows the classic cupping as seen in this case, while occlusion results in a thin radiolucent line all around the implant. What are your thoughts on this?
I would personally remove the most distal implant and treat the second most distal with a combined regenerative/resective approach.

I look forward to see the rest of this case.
Best regards,


Ehab; I agree with your treatment decision. Interestingly, I believe that Alberto is on to something above....some causes can start as occlusal in nature and then transition into a perio lesion? What say you? Dr. S


A few questions and the last abutment appears to be zirconia in nature any special reason is the screw retained versus cement ? We’re all implants placed at the same time date Paris to be a combination of implant types not necessarily different manufactures like different types with in the same family
What is the bio type of this patient ? male or female and being that this is the most distal implant I wonder if the hygiene optimal around here as it is a four unit splinted in which I feel hygiene can be a touch
difficult - lastly what is the maxillary opposing occlusion?




Hi Dr. S ,
i would remove bridge check if there is cement washout , my intial suspision would be that the main bearer of the function of this bridge (because of the way it was planned) is primarily the screwed in implant and hence it is the one to fail due to overloading...
For that reason if it were up to me i would make them all cement retained even if last abutment would have to be a little shorter because of space...
Have a good day


Good thinking...I agree. poor prosthetic planning by lab and restorative team.


Curious, what is the opposing occlusion? Has the maxillary occlusion changed over the period of breakdown?


James no....implant supported fixed bridge


Hello. Perhaps screwing the screw led to the extension of the implant. The remaining implants served as support for this. Example of orthodontics


Zalim; Perhaps....but more than likely screw retained unit only one supporting 4 units of occlusion as cement washes out? Dr. Salama


It could be related to the lack or absence of keratinized gingival seal around the distal implant.
I had failures like that, for this specific reason, even on large diameter implant sizes.


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