Direct answer

Bone loss does not automatically prevent ceramic implant treatment. A deficient ridge before placement may sometimes be reconstructed or managed with another plan. Bone loss after placement may reflect early remodeling, peri-implantitis, unfavorable position or loading, or another cause. Examination and serial imaging are needed before choosing treatment.

Key takeaways

  • Pre-treatment ridge deficiency is different from progressive loss around an implant.
  • A single image cannot always show whether bone is actively changing.
  • Ceramic material alone does not prevent or repair bone loss.
  • Implant position, tissue health, loading, and cleanability must be assessed together.

Bone deficiency before implant placement

After tooth loss, the ridge commonly changes in width and height. Periodontitis, infection, trauma, anatomy, or previous surgery may add defects. Three-dimensional imaging may be used when it will change planning. Options can include grafting, staged treatment, altered implant dimensions or position, or a non-implant restoration.

Bone change after implant placement

Some remodeling can occur after placement and restoration. Progressive bone loss accompanied by bleeding, deeper probing, or suppuration raises concern for peri-implantitis. Bone change can also relate to implant position, tissue dimensions, restoration design, overload, or mechanical failure. The pattern and trend matter.

How clinicians evaluate bone loss

Evaluation may include symptoms, probing and bleeding, implant mobility, restoration fit and cleanability, bite forces, baseline and current radiographs, and three-dimensional imaging when justified. Radiation exposure should be matched to the diagnostic need.

Treatment depends on the cause

Management may include controlling inflammation, improving hygiene access, adjusting or replacing a restoration, treating peri-implantitis, grafting a deficient site, protecting against overload, monitoring a stable condition, or removing an unsalvageable implant. Bone grafting is not a universal answer to every radiographic defect.

Selected references

  1. Herrera D, et al. Prevention and treatment of peri-implant diseases—The EFP S3 level clinical practice guideline. Journal of Clinical Periodontology. 2023. doi:10.1111/jcpe.13823.
  2. Berglundh T, et al. Peri-implant diseases and conditions: Consensus report of workgroup 4 of the 2017 World Workshop. Journal of Periodontology. 2018. doi:10.1002/JPER.17-0739.