The crowns were never seated properly on the implants in my opinion (see the gap on the radiographs).

At least that is my opinion……now it could be the impression abutments werent seated or the final abutments not seated. There will be tissue in there now.

What kind of implants are these (corevent is my guess) and do they have an HA coating.

An erbium laser will absorb the HA and leave you with a titanium surface . It will also sterilize the area.

I have one case going on right now like this……waiting to see how it heals.

In my case the implant turns but the basket must have some bone in it as it wont pull up out of the way. I put the healing cap in and closed flapped it.

I will open flap it if it still turns in 3 – 4 months.

Its all experimental but in my case its on my mom who has the failing implant and I think she wont sue me!!

cya

Glenn

Thought you guys might find this useful-
J Oral Maxillofac Surg. 2005 Oct;63(10):1522-7. Related Articles, Links  

Surface properties of endosseous dental implants after NdYAG and CO2 laser treatment at various energies.

Park CY, Kim SG, Kim MD, Eom TG, Yoon JH, Ahn SG.

Department of Oral and Maxillofacial Surgery, Oral Biology Research Institute, College of Dentistry, Chosun University, 421 SeoSeogDong, GwangJu City 501-825, Korea.

OBJECTIVES: Dental lasers have been used for uncovering submerged implants as well as decontaminating implant surfaces when treating peri-implantitis. The objective of this study was to compare the possible alterations of the smooth surface and resorbable blast material (RBM) surface implants after using NdYAG and CO(2) lasers at various energies. MATERIALS AND METHODS: Ten smooth surface implants and 10 RBM surface implants were used. Two smooth surface implants and 2 RBM surface implants served as a control group that was not lased. The remaining implants were treated using NdYAG and CO(2) lasers. The surface of each implant was treated for 10 seconds on the second and third threads. The smooth surface implants (group 1) were treated using a pulsed contact NdYAG laser at power settings of 1, 2, 3.5, and 5 W, which are commonly used for soft tissue surgery; the corresponding energy and frequency were 50 mJ and 20 Hz, 100 mJ and 20 Hz, 350 mJ and 10 Hz, and 250 mJ and 20 Hz, respectively. The group 2 RBM implants were treated using a pulsed contact NdYAG laser. The group 3 smooth surface implants were treated using a pulsed wave non-contact CO(2) laser at 1, 2, 3.5, and 5 W, and the group 4 RBM implants were treated using a pulsed wave non-contact CO(2) laser. Data were analyzed using scanning electron microscopy. RESULTS: The control surface was very regular and smooth. After NdYAG laser treatment, the implant surface showed alterations of all the surfaces. The amount of damage was proportional to the power. A remarkable finding was the similarity of the lased areas on the smooth and RBM surfaces. CO(2) laser at power settings of 1.0 or 2.0 W did not alter the implant surface, regardless of implant type. At settings of 3.5 and 5 W, there was destruction of the micromachined groove and gas formation. CONCLUSION: This study supports that CO(2) laser treatment appears more useful than NdYAG laser treatment and CO(2) laser does not damage titanium implant surface, which should be of value when uncovering submerged implants and treating peri-implantitis.

Note “contact”. Seems to indicate that, like endo, a distance from the target(4mm?) should be respected, as well as the angle. Bob, thoughts?

Bob,

Is it correct to assume that a mostly end cutting fiber such as used on the FR:NdYag would be fine if kept parallel to the implant surface ?

Would it be prudent to wipe the tip more frequently to prevent any nonendcutting heat from building up on the fiber tip ?

Bruce

One of the things to consider is that if you flapped the case that the surface of exposed hydroxyapatite could be easily removed with the erbium lasers. THe hydroxyapatite is readily absorbing the erbium lasers and it will do little to the titanium surface. Water spray keeps everything cool so it might be the way to go in my opinion as the right wavelength for this type of failing implant. The wavelength will strip of the HA and will sterilize and not heat up bone.

The ongoing problem of course is the gap between superstructure and the implant itself.

I think that you will see with time that erbium lasers will become a treatment of choice for failing implants. Lots of research looking at this now.

Glenn

David I will tell you that the distal implant will be a piece of cake, the mesial a real huge headache.

I just tried to remove one on my mom which was exactly the same Corevent HA coated implant. It spun but wouldnt come out.

I finally closed flapped around the implant with the erbium, removed the superstructure and then put a healing cap in.

Will see in 3months and most likely then will flap it to see what can be done. I could spin the implant but no way could I get it up…..

It looked just like your mesial one on the radiograph.

Glenn

to remove teh spinning corevent is easy – section it, just as you would a tooth. High speed carbide fissue burs with good coolant water spray. Bone removal not required.