Losing Bone on My Dental Implant -Too Much Cement?

Losing Bone on My Dental Implant -Too Much Cement?

Losing Bone on My Dental Implant -Too Much Cement?

Too much cement used on a dental implant crown or bridge can easily cause bone loss around both new and old implants.  It sounds counterintuitive to purposely use less cement for an implant than you would for a crown on a natural tooth.  If left untreated, it can be one of the worst dental implant complications to occur and can cause implant failure.

Unfortunately this is a complication that I see here in my office in Burbank fairly routinely.

Here is how it works:

When a crown is cemented on to an implant, the cement can get beyond the gums and touch the bone. This is possible because the gum pocket around a tooth and the gum pocket around a dental implant are very different from a biologic standpoint. Your natural teeth have a tighter seal at the gum level.

The straight red line indicates the good bone level. The dipped down line indicates the bone loss

There are different cements and bonding agents that I use for dental implants, but the bottom line is no matter what is used, the cement gets so thin, it can easily slip below the pocket.  It is near impossible for the dentist or the patient to see this.  A seasoned dental implant dentist understands this concept and should go to great lengths to prevent it.  It is based on the technique of the dentist, not the brand or type of cement.

I have developed a specialized technique for cement and bonding dental implant teeth over a decade ago.  Aluminum oxide blasting, dental implant analog cementation, and retraction cord are just a few of several techniques I use.

The center portion of the dental implant was removed by Dr. Amin. The bone loss was too severe to correct. The teeth on top stayed unharmed though.

How do you know there is too much cement?

Shortly after having a dental implant with too much cement, the gum bleeds, there may be pain and/or infection, and the gum may recede. If this is not handled quickly, permanent bone loss may ensue.  The gum usually does not grow back.  Bone can be grafted back only in some situations.

What is the disadvantage of using special techniques to use less cement?

The main disadvantage is that the crown or bridge may come out. A crown  that comes out is easily replaced, while bone and gum loss from too much cement is not easy to fix.  It is worth it.

There are many other reasons why a dental implant can lose bone; too much cement is only one of the reasons.  Please read more of my blogs and watch other videos if you would like to learn more. Dental implants are still the absolute best way to replace one tooth or all of your teeth.

Ramsey A. Amin, D.D.S.
Diplomate of the American Board of Oral Implantology /Implant Dentistry
Fellow-American Academy of Implant Dentistry
Burbank, CA

14 Comments

  1. Scott B

    I just finished my implant procedure 3 days ago with the cementing of the crown. I wish I had found your web site before that day! Now I’m terrified about the possibility of peri-implantitis from the cement used to attach my new “tooth.” My dentist didn’t do an x-ray after the placement. How concerned should I be? Should I make an appointment with my dentist right away to address this concern? I’m annoyed that I wasn’t given the option of a screw-attached crown, which is the option I would have chosen had I been aware. Thanks for some very helpful information!

    February 23, 2017 at 11:31 pm Reply
    1. RamseyAminDDS

      Just go back and have a simple X-ray done. I’m sure it will look fine. Screw attached teeth are not without problems and are not a cure all for cement issues. I probably do 50/50 cement and screws.

      Screw teeth can break and are many have cemented parts at the abutment junctions where zirconia meets the titanium.

      An X-ray after it is placed is always a great idea. All of these issues usually arise from technique errors not the cement itself.

      February 24, 2017 at 2:27 pm Reply
  2. Selena G.

    Hi doctor

    I am in the process of getting an implant, the next step will be cementing my crown. My dentist seems and claims she’s got good experience but given I am terribly scared of her doing a bad job and getting peri implantitis maybe losing bone and more teeth/molars, how can I help make sure she uses little or about enough without offending her?What can I do to make sure its the correct amount or less than necessary? how much is this quantity? (in oz.?)

    I want to trust my doctor but definitely I feel one cannot be too sure. Appreciate it.

    December 20, 2016 at 5:53 pm Reply
    1. RamseyAminDDS

      There is no measurement for it. We just described it as a very light lining of cement. Even if you use a bit too much it’s just important to clean the excess out and take a x-ray afterwards to make sure no cement is visible under the gums where it cannot be seen by the naked eye.

      December 26, 2016 at 3:26 pm Reply
  3. Brian M

    Had 2 dental implants following a bone graft about a year ago. Recently, I noticed some bleeding and irritation from the area. I visited the periodontist and he removed excess cement from the area.

    He also told me that there is 50% bone loss inn the area.

    What are the chances that my implants will now fail? Should I be upset? The periodontist told me that things like this happen when dealing with implants.

    October 26, 2015 at 9:48 pm Reply
    1. RamseyAminDDS

      Ugh….bad story… I am sorry you’re having trouble. Speak to your periodontist about the possibility of bone grafting around the existing dental implant. Sometimes it has a very good prognosis and sometimes it does not. This is a very technically difficult bone graft to do. I would suggest combining graft material with a biologic enhancers such as L PRF and/or PRP.

      It may be less costly, more predictable to just replace the entire implant again. Sorry for the bad news. Cement gets beyond the abutment and onto the implant it is almost certain death from the bone.

      Happy Thanksgiving

      Very respectfully,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      November 27, 2015 at 6:34 pm Reply
  4. JP

    I had a crown placed over a molar that was wearing thing. No root canal, and no pain prior to the crown. Following the temporary crown I had excruciating pain for about a week, and bleeding gums. Then the permanent crown went on and the excruciating pain lasted another 2 weeks. Only solution was Ibuprofin all day every day during this time. I still get pain, and cannot really chew hard foods on that side. I also have bleeding when I floss around the tooth unless I very slowing ease the floss down the sides of the tooth. It appears there is a thin line of cement at the gumline, but hard to tell. The dentist said I need a root canal, but I’m wondering if I should get a 2nd opinion from a periodontist. Any advice?

    February 6, 2015 at 6:39 pm Reply
    1. Ramsey Amin DDS

      This blog is intended for helping people with dental implant and bone graft type of questions….. But it does sound like you need a root canal….. Sorry for the bad news!!!!!

      Ramsey Amin DDS

      February 15, 2015 at 2:05 am Reply
  5. Alissa

    I had an implant done about 10 years ago Nd my dentist told me I was loosing bone in that area and to make an appointment with the surgeon. I was at his office today and he said he may be able to fix it,but no guarentee in how long it will last and it will fall out. He said something like 10-10-10 on one side and 3-3-3 on the other and he would have to adjust my gum to permanently expose the area, so I can keep it clean. I was hoping that he could just put more bone I. The area and put it back. Should I see another Dr.? Did he do something wrong? I was told these last 25 years.

    October 16, 2014 at 4:22 pm Reply
    1. Ramsey Amin DDS

      Hi Alissa,

      There is no way to guarantee anything in the human body. People get hip and breast implants all the time that did not even last 10 years. The condition you likely developed is call peri-implantitis and can often be treated with a complex bone graft. The situation has to be just right, for it to work. If not, you may want to consider the surgery that has been recommended or remove this implant and replace it with the new one.

      I know you are really bummed out about it but at least it is not your kidney or liver that is failing.

      I would suggest that you have growth factors made from your own blood added into your graft if you’re going to have this procedure done.

      What is Peri-implantitis and What Do I Do About It? – Bone Loss Around Dental Implants ~Burbank Dentist, Ramsey Amin Reviews

      Do I Need PRP/PRF/PDGF/BMP For Dental Implants and Bone grafts?

      Respectfully,

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry
      Burbank, California

      November 3, 2014 at 3:09 am Reply
  6. Olia

    Can too much cement be visible on regular x-ray? How doctor can see if he used too much cement?

    May 7, 2014 at 11:41 pm Reply
    1. Ramsey Amin DDS

      Hello Olia,

      Most of the time extra cement that goes under the gum line of a dental implant crown and abutment cannot be seen on x-ray. Depending on the type of cement used and the amount of cement presents it is either visible or invisible on x-ray. Sometimes the only way to know is to surgically open the area and check.

      This continues to be one of the most common problems I see in my office. The dentist who cemented the crown has no ill intentions but just does not understand dental implant crowns. Too many times people choose inexperienced dentists (based on insurance and money usually) to make their dental implant crowns which are critically important to the long term success of the implant and its surrounding bone.

      I have extracted many implants due to excessive cement left behind inadvertently. It causes tremendous bone loss.

      Ramsey A. Amin, D.D.S.
      Diplomate of the American Board of Oral Implantology /Implant Dentistry
      Fellow-American Academy of Implant Dentistry

      May 14, 2014 at 5:13 pm Reply
  7. San M.

    “Losing Bone on My Dental Implant – Too Much Cement?” The Title itself makes us interested to look into the matter … I just gone through the blog and it was really an informative stuff…I hope people will find this blog helpful… good job..not too many people out there are as good as you!

    March 30, 2013 at 2:35 am Reply
    1. Ramsey Amin DDS

      thank you!

      Dr. Amin

      April 1, 2013 at 3:39 pm Reply

Write a Comment

Monica D.
Monica D.
December 29, 2020.
There aren't enough words (and I have a lot of words) to tell you how grateful I am to have found Dr. Ramsey Amin and his wonderful staff. I had an enormous amount of bone loss and I was hopeless after being treated by a different doctor for two years. I had multiple procedures such as gum graft, extractions, and a sinus lift. After all of that, the doctor released me and told me he could not help me any longer. He sent me to a large teaching hospital - who also had no idea how to help me. I was terrified and embarrassed. I had been missing teeth due to those procedures since 2017. That sent me out on a journey of meeting with no less than five different dentist/oral surgeons. Most of them shamed me for the bone loss and wondered what I had done to cause this. In reality, I had done nothing. The bone loss is my body's immune system fighting me, as well as hereditary traits. In fact not only was I having difficulty being able to have implants, I also had so much bone loss that I was also not a candidate for dentures. I researched "what to do when you have bone loss and can't get implants" and I found Dr. Amin's website. Then I researched him, read his reviews, watched every one of his You Tube videos. I called and got an appointment, and kept going to consultations with other providers. I had long since stopped smiling and being social. Missing teeth and the shaming was affecting my life so adversely. When I met with Dr. Amin for my consultation he was ready. He had all of my records and had already reviewed my scans. But more than that, he genuinely wanted to get to know about my life. He was/is authentic, kind and extremely professional with so much success and experience in difficult cases like mine. He worked up a treatment plan & I came back two weeks later to discuss my options...and the journey began. I have had three procedures under IV sedation, no pain, no narcotics needed for aftercare. Dr. Amin is a consumate, experienced oral surgeon who cares about your health & understands your fears. He communicates every step of the way and will provide you with all the information you need to make a decision to improve your health. I am still working toward my end goal, and we had to zig from traditional implants and zag to zygomatic implants instead...which is the reason I chose him in the first place. If there was nothing else that could be done to get me healthy & smiling again, I knew he would have that option to help me. And of course 2020, the year of CV-19. Don't worry, Dr. Amin & his staff follow all health & safety protocols. This review is long, because it is important you know my journey, so you might understand how fortunate I feel to be healing. I'm torn, because this place is like a great restaurant, I want to shout from the rooftops how great it is, how great he is. And at the same time, I want to keep this all to myself. I come 75 miles each way to see him. I know people travel from all over the world for his expertise. Do yourself a favor, have a consultation. You won't regret it. Dr. Amin is amazing and so is his staff.
Jennifer B.
Jennifer B.
December 18, 2020.
I cannot speak highly enough of Dr. Amin and his professional staff. I have to start off and say that I am absolutely TERRIFIED of the dentist due to several past experiences. I found myself putting this off for YEARS until I was referred over to Dr. Amin. I was petrified on my first visit... but he along with his WONDERFUL staff made me feel so calm and at ease. I had quite a bit of work that needed to be done, but we found the perfect plan that worked out for me, and I couldn't be happier. Words cannot express my gratitude to each and every staff member that made me feel safe and comfortable. Dr. Amin was always so attentive in asking if I was ever in pain... and I never was. These are truly remarkable individuals, and I'm so lucky to have a dentist that I can trust. I ABSOLUTELY LOVE each and every one of you! Thank you,
D M.
D M.
December 17, 2020.
I cannot say enough positive things about Dr. Amin and his staff. I originally found them on Yelp about two years ago. I needed an implant, front tooth of all places, and was extremely nervous not only about surgery but about how it would turn out. Let me just say I just adore the staff. Everyone is crazy friendly and the whole office has a very positive vibe. The staff is adorable and always has me smiling by the time I leave. They are all thorough and on-point about what they do, and I truly appreciate it. They are quick to respond to my emails no matter the question, and their appointment reminders are great too. Dr. Amin is very thorough and reassuring, and answered any questions my husband or I had. My regular dentist had questions about the procedure and Dr. Amin's office even reached out to them at my request (my dentist said they never received a call, but Dr. Amin's staff had date, time and notes - love the thoroughness!). After surgery the Dr. called to leave me a message about how it went. Very minimal pain during healing, never any pain during any visits. It took a few tries to get everything just right for the permanent crown (color, etc), but the end result is beyond fantastic! At one point during healing I thought I was experiencing some looseness or wiggling but unfortunately couldn't make it to the office. When I was finally able to make it in the Dr. was so relieved, bless his heart. Luckily it was just a false alarm and everything checked out ok. They're a bit further out from me, but I wanted the best. I sure found it! I wish they were my regular dentist, and I'm looking forward to seeing them again for my check-up which was delayed due to COVID.
Melissa E.
Melissa E.
December 9, 2020.
I found Dr. Amin a few years back after I hadn't been to a dentist in a decade. Many traumatic dental experiences in childhood have made me so phobic that even getting a cleaning was a knee-knocking, heart-pounding trial. But finally I couldn't put off some things any longer. During my first anesthesia session, Dr. Amin replaced five old metal fillings, and during the second he did three more plus a crown. I was completely comfortable, and never felt a thing. Because they were extra-long sessions, I did sleep for about 12 hours after, but the next day I felt just fine. This past week, my back top tooth cracked in half and fell out of my mouth, and a couple days later the crown on the remainder of the tooth fell out too! Despite being nervous about Covid 19, I had to get it taken care of, so I called and quizzed the staff about precautions, which turned out to be even above and beyond what I would have expected. So yesterday I went for the tooth extraction and plug. After they put on the blood pressure cuff and put in the IV, I gradually got a little tired and closed my eyes. I sat there for about 10 minutes and thought Gee, I wonder if they're going to get started any time soon, and a minute later Dr. Amin said "Wake up, you're all done!" That was a short session, and I didn't have the kind of fatigue I did my first time. I stayed up most of the evening. Today, everything is good! I'm taking my antibiotic and eating soft foods, and there is surprisingly little pain now that the numbness has worn off. The tooth site and my cheek are a little sore, and the corner of my mouth, and I have a very slight headache, but nothing to any great level--I'm not even taking the acetaminophen. I feel good, and wide awake. Thanks to everyone at the office for a comfortable and professional job! I really REALLY appreciate you for giving me painless dental experiences!
Tanya S.
Tanya S.
December 3, 2020.
What can I say about Dr. Amin he is the best! I'm so grateful for him. He has literally changed my life and given me the confidence to smile more. I had major restorative dental work done and everything went smoothly. Dr. Amin is very compassionate and he really cares about his patients he made me feel comfortable and cared for. He is very knowledgeable and has a great sense of humor. His office is very clean and they take the patients health and safety very serious. His staff is also amazing they made me feel very welcomed and important. I'm so happy I did my research and found Dr. Amin.  Thank you Dr. Amin and team.
Sheila S.
Sheila S.
November 6, 2020.
Two implants done! Finished all procedures and I couldn't be happier. It's the first time in years I looked forward to going to the dentist. Even during Covid life the staff and Dr. Amin took care of me. There is a possibility I may move to Long Beach but I would still travel to keep Dr. Amin as my dentist.
Allison S.
Allison S.
November 4, 2020.
I could not ask for a more caring, exceptionally knowledgeable dental care provider. He's not just a dentist, but someone who looks after your immediate dental needs and helps you plan and prepare for the future.
Julia R.
Julia R.
October 8, 2020.
I've been going to Dr. Amin since I turned 16 and have been going since. Before going to Dr. Amin's dental office, I had 4 crowns that I was not happy with and dealt with it until finally I asked Dr. Amin and because I  feel comfortable and because I trust him with his work I recently had my crowns fixed and worked on by  Dr. Amin and have never loved my smile the way I do now, I can actually enjoy my pictures, I can enjoy my smile from either angle and that really mattered to me. Thank you so much Dr. Amin still and will be in love with MY smile
Aaron D.
Aaron D.
October 6, 2020.
I've been coming to Dr. Ramsey for about five years and I have to say, he is by far the best dentist I've had - ever. The staff is professional and kind, the office is exceptionally well maintained, and Dr. Ramsey is careful and extremely knowledgeable about current developments and research in dentistry. I recently had a dental implant which was a long process but well worth it. I required a sinus lift as well as a bone graft. The surgery went off without a hitch, I was comfortable and the healing process was quick and without complication. Highly recommend!!
Flo O.
Flo O.
September 21, 2020.
This is my 1st review of Dr. Amin, and in my over 17 years of being with him, my experiences with Dr. Amin and his staff have always been positive.  I don't recall a bad experience with the several implant procedures i have had.  They run an efficient office.  I like that they are proactive and reach out to their patients to remind us of routine care needed.  Dr. Amin's bedside care is impeccable.  They are also technologically up to date in terms of sending out texts as reminders, ability to incorporate any appointment into your mobile phone.  That is certainly a plus.  Keep up the great care!!!