Treatment of a Patient With Implant Failure and Jaw Osteonecrosis: Successful Retreatment Using Implants

Figure 1. (a) Initial clinical presentation of patient with failing reconstruction. (Patient had been on oral bisphosphonates for 1 year). (b) Panoramic radiograph of initial presentation showing failing reconstruction. Figure 2. Panoramic radiograph of maxillary implant-supported reconstruction in place following Teeth in a Day immediate load protocol. Figure 3. Panoramic radiograph of 6 immediately loaded Brånemark fixtures placed following extractions (4 years following maxillary implant reconstruction; patient had been on oral bisphosphonate for 5 years). Figure 4. Ulceration in #22 area. Figure 5. Left inferior border of the mandible with purulent drainage (with permission from Quintessence). Figure 6. Open debridement of the mandible. Bone destruction, pus, granulation tissue, and apices of the dental implants were encountered (with permission from Quintessence). Figure 7. Four of the 6 implants were completely mobile and removed (with permission from Quintessence). Figure 8. Closure of the mandible after debridement (with permission from Quintessence).

Figure 9. (a) Panoramic radiograph of remaining 2 implants supporting removable overdenture prosthesis. (b) Intraoral view of gold bar supported by 2 fixtures. (c) Intaglio view of mandibular prosthesis with 2 Hader clip attachments. Figure 10. Four mandibular implants placed posteriorly following a 2.5-year drug hiatus. Figure 11. Final mandibular prosthesis. Figure 12. (a) Panoramic radiograph 11 years postoperative of maxillary reconstruction and 5 years of mandibular retreatment. (b) Intraoral view of maxillary and mandibular prostheses 11 and 5 years postoperative for maxillary and mandibular prostheses, respectively.