Bone Loss Around a New Lower Front Implant: Removed Early, the Ridge Rebuilt, and a Replacement Implant Restored

A compromised new implant replaced on a rebuilt foundation

Corrective implant treatment in Washington, DC for a patient referred for restoration of a lower front implant that had been placed a few months earlier to replace a congenitally missing tooth. This documented case at Elite Prosthetic Dentistry found pocketing, bone loss, and exposed threads around the implant, removed it before further integration, rebuilt the ridge with widening and bone grafting, and placed and restored a replacement implant with a customized abutment and crown. Treatment was planned and completed by Gerald Marlin, D.M.D., M.S.D., a prosthodontist who plans implant foundations and final restorations together.

The presenting condition

This patient had been missing several teeth from birth and had completed orthodontic treatment with clear aligners to open the proper space for an implant at a lower front tooth site. The implant was placed in the spring and exposed that summer. When she and her mother came to the practice for the crown, the evaluation found approximately 5 mm pocketing on the mesiofacial and distofacial aspects of the implant, bone loss, and exposed implant threads. Early bone loss around a recently placed implant can happen for a number of reasons, and it is not always visible from the outside. An abutment and crown could technically have been made. The question was whether a restoration on that foundation would last.

Why the implant was removed rather than restored

Dental implants depend on healthy surrounding bone and soft tissue for long-term stability. An implant can be present in the mouth and ready for a crown from a mechanical standpoint while the tissues around it are already failing. Pocketing of 5 mm and exposed threads on a lower front implant indicated a foundation that could not be expected to hold a crown predictably; the likely course would have been progressive bone loss and, eventually, a far more difficult revision with the crown already in place. Because the implant had been placed only a few months earlier, removing it now, before it integrated more extensively, offered a cleaner opportunity to rebuild the site. The philosophy in complex implant care is to address the underlying condition rather than restore over it. The treatment became a sequence: remove the compromised implant, rebuild the ridge, allow it to heal, and only then place and restore a new implant in bone that could carry it. See dental implant bone loss for how these findings are evaluated.

The treatment plan

The plan put the foundation first, so the final crown would sit on an implant with a future.

The outcome

The compromised implant was removed before the condition could become more advanced, the site was reconstructed, and a replacement implant was placed and restored with a customized abutment and crown. The photographs at the top of this page document the sequence: the original implant with exposed threads and the probing that measured the pocketing, the replacement implant in the rebuilt ridge, the radiograph of the new implant seated in bone, and the completed crown among the natural teeth. The case illustrates a principle in implant dentistry that is easy to state and hard to follow: a predictable result sometimes means taking a step backward before moving forward.

Who this case may sound familiar to

This story tends to resonate with patients in a few recognizable situations:

• You have a recently placed implant and have been told, or suspect, that the bone around it is not healthy.
• You were referred for an implant crown and want a specialist to confirm the implant is sound before the crown is made.
• You or your child are missing teeth from birth and want the replacement planned to last for decades.
• You want a practice that will tell you when the right step is to rebuild rather than to finish.
• You want the foundation done correctly so the crown is not the first part of a longer problem.

Our goal is to help patients make thoughtful long-term decisions, whether treatment is limited or comprehensive. Sometimes the thoughtful decision is to rebuild the foundation before the final restoration is made.

If any of those describe where you are, a consultation with Dr. Marlin can give you the diagnostic picture and the specific plan for your case.

Frequently asked questions

What does bone loss around a new implant mean?

Bone loss shortly after placement, especially with pocketing and exposed threads, indicates that the implant does not have the healthy, stable support it needs. It can result from a number of factors in the site, the healing, or the surrounding tissue. The finding has to be evaluated before any crown is made, because a crown cannot fix the foundation under it.

Why remove an implant instead of placing the crown and watching it?

Restoring an implant that is already losing bone usually leads to more bone loss and a more complicated revision later, with the crown in the way. When the implant is recent and not yet extensively integrated, removing it early and rebuilding the site is often the more predictable path to a replacement that will last.

How is the site rebuilt after an implant is removed?

After removal, the ridge is evaluated for width and height. Ridge widening and bone grafting restore the dimensions a new implant needs, the site is allowed to heal, and the replacement implant is then placed into reconstructed bone rather than into the defect the first implant left behind.

Can an implant that was placed elsewhere be evaluated and restored by a prosthodontist?

Yes. Prosthodontists frequently receive patients referred for the restorative phase of implant treatment. Part of that role is confirming that the implant and the surrounding bone and soft tissue are sound before the abutment and crown are designed, and recommending corrective treatment when they are not.

More about the work behind this case

This case combines corrective implant treatment with ridge augmentation and a replacement dental implant. The foundation-first decision reflects the practice’s philosophy on long-term planning, and the crown was fabricated with the in-house laboratory.

Elite Prosthetic Dentistry treats patients from across the DMV including Bethesda, Chevy Chase, McLean, Arlington, Potomac, and Great Falls, and from much further out for cases that warrant the trip.