Treat the WHOLE not the HOLE

I recently had a patient, Greg, who came to me for a second opinion regarding his failed dental implants. He was a very busy executive and didn’t have time for these things, as he explained.

He had two implants placed a month prior to seeing me and two of them failed already. Looking at the X-rays and his records, everything was done by the book. His surgeon even used a computerized guided procedure which allows us to plan the surgery on a 3D computer program, after which a guide is fabricated.

But what really went wrong?

I started to examine the rest of the teeth only to find out that he had advanced periodontal disease, which is an infectious disease of the surrounding gums and bone. This infection is caused by pathogenic bacteria, which attack a susceptible host with a genetic predisposition.

I asked the patient if he was aware that he had this disease, periodontal disease that is. He said “No, I wasn’t, but the dentist recommended a deep cleaning, which I declined. I just thought it was a way to get more money out of me.”

Mechanical therapy, either hand instrumentation or ultrasonic debridement, is the most common therapy for periodontitis and its success is well documented (Badersten et al. 1984). This non-surgical therapy involves considerable amounts of time, a high level of operator skill, and dedication, hence it is worth the investment.

When I looked in Greg’s mouth, I saw inflammation of the gums and deposits of plaque, which is 99% bacteria, nearby the implants which failed. The bacteria most likely infected the implants, damaged the surrounding bone, and caused the implants to loosen. If this periodontal disease would have been treated properly, these implants would not have failed.

If there’s one thing to learn from this, it is to pay attention to the whole mouth, not just the hole we are trying to fill with the implant.

In my office, I have established a full mouth disinfection program, which ensures that all tissue are clean, gums, teeth, cheeks, tongue, and back of the throat. This has been scientifically proven to be effective. Bacteria travel throughout our bodies, it doesn’t just stay around one tooth. It can infect and affect implants on the opposite side, but also knees, lungs, brain, heart, and stomach, to name a few. Maintaining good oral hygiene is a must!