It needs to come out. I would do a synthetic bone graft at the same time and not put anything back for 6 months. You could put another chin implant, but it needs to be fixated to the bone wiht screws as it is the micromovement that produces this type of erosion.
Joe Niamtu, III DMD
Cosmetic Facial Surgery
This is classic chin implant settling, not a true inflammatory erosive process. It is most commonly seen from the intra-oral placement of chin implants where the implant has been positioned too high over the thinner cortex of bone near the tooth roots. It is probably a process that is stable and further settling into the bone is unlikely from where it is now. Unless you are having tooth sensitivity, there is no urgency for removing it. If you do remove it, it can be simultaneously replaced with either a sliding genioplasty or a new implant secured in a lower better position with screw fixation. If a sliding genioplasty is chosen then it can be done intra-orally. (with a better incision location than the one you have now) If an implant replacement is chosen then it can be done from a submental incision on the underside of the chin. There is no reason to have separate surgeries for removal and any form of new chin augmentation. Given the size of the bone defect, it can be filled in with demineralized bone paste or granules to restore some bone thickness.
The implant is not in the optimal position. It is high, which is a more commonly seen with the intraoral insertion versus an external skin incision. should be lower, at the bottom of your chin. Now it is pressing near the tooth roots which is not good. A sliding genioplasty (osteotomy with sliding of the chin forward and plating it in place) is a great way to augment the chin. It is fairly straightforward in experienced hands. Of course, a plastic surgeon, oral surgeon or maxillofacial surgeon should be the one to help you decide between a sliding genioplasty versus another implant after an in person consultation. Best wishes.
I think your implant is too high, which is common with intraoral placement. It is not projecting where you need it. Though some might want to do a bony advancement this is a bigger and not necessarily better surgery. I would remove your implant from below and put another in where it belongs on the point of the bony chin. Simple and effective.
I would recommend removal of the implant and an advancement genioplasty. This will allow you to have a larger advancement than with a chin implant replacement. The recovery is comparable for both. Good luck. Donald R. Nunn MD, DDS Atlanta Plastic Surgeon.
I think the simplest and safest procedure would be to remove the current implant which is too high and replace it from below. The external placement from below allows it to be secured and placed flush with the lower edge of the mandible.
Get the implant out asap. It could damage the teeth roots which could lead to many dental treatments to resolve. As to rehabilitation, a sliding genioplasty will easily and more capably fix the contours; and one can also manage the bone loss/contour at the same time
Only in person evaluations allow a determination if the aggressive bony work is needed. Good luck.///