Had a Spinner with Zimmer Implant: Best Protocol?

posted in Surgical Placement of Dental Implants, advice

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Dr. VD, a prosthodontist, asks:
Last week while placing a Zimmer tapered screw vent implant in tooth #15 region [maxillary left second molar; 27] I had a spinner [implant rotated while being torque into place]. I managed to place the cover screw and achieve primary closure. While discussing this case with an orthopedic surgeon, he said in his practice if they have a loose implant they use ‘bone cement’. They also prophylactically put their patients on a 3 months drug regime of Ostoefos [Fosamax, alendronate; a bisphosphonate]. How safe would it be to use the same protocol for the surgical placement of dental implants?

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12 Responses to “ Had a Spinner with Zimmer Implant: Best Protocol? ”

  • Carlos Boudet, DDS July 26th, 2010

    Dr VD
    Bone cement and prescribing a biphosphonate may be this orthopedic surgeon’s protocol for dealing with a loose implant, but I doubt it has any value here.
    A spinner is handled by going deeper (especially with tapered implants) or using a wider diameter implant.
    If you closed the surgical site, then you already decided to take a chance, and see what happens.
    There are occasions where the spinner implant will integrate, but it is not predictable.
    If you decide to take a chance on it, a longer than normal period for osseointegration is advisable.
    Good luck.

  • Peter Fairbairn July 27th, 2010

    This is not a “spinner” just low primary stability was achieved , merely use a longer or wider implant or if you do not have you can place graft particles into the osteotomy. I am sure your case will be fine though as the bone will grow close to the implant.
    A spinner is when the implant rotates at the loading phase due to lack of integration and here removal is best.
    I am amazed at the orthopaedics use of bisphophonates though this shows our different approaches to oseointegration.

  • Ben July 27th, 2010

    I had a similar situation but could not back out the implant so no option of wider or longer.

  • MJK July 27th, 2010

    Actually, the term spinner is a fine way to describe an implant that simply “spins” and will not achieve adequate primary stability during placement.

  • narayan July 27th, 2010

    was the implant spinning when you tightened the cover screw?if you have primary stability of 20 ncm,and CLOSED healing you can expect the implant to integrate,albeit your waiting period increases to 5-6 months.

  • David Nelson DDS July 28th, 2010

    I agree with most of the other posts. However I disagree on removal. If there is no soft tissue invading the site and the implant is in direct contact with bone the best thing is to leave the spinner for 6 months to continue osseointegration. This was the answer given to me by Dr Jack Hahn, and it worked.

    Good Luck

  • Richard Hughes, SS. FAAID, FAAIP, DABOI July 29th, 2010

    David Nelson, Your comment reminded me of a case that I did eons ago. I was using Steri Oss press fit implants at that time (a good system). I had one that was a spinner. I pressed it up against the wall and placed a dense HA in the remaining portion of the extraction site and fixated the implant…..resulting in a screaming success.

  • Jerry Niznick July 30th, 2010

    Was it a straight Screw-Vent or a Tapered Screw-Vent? Zimmer is still selling both. The tapered Screw-Vent with a soft-bone, hard bone protocol was developed in 1999 to overcome lack of initial stability. With the tapered implant in soft bone you need to stop at the intermediate drill and let the implant expand and compress bone as it is being inserted, thereby increasing initial stability. The VA Study conducted in the early 1990’s using 3000 Core-Vent/Paragon implants including about 1000 Screw-Vents, showed that if you had a spinner with an HA coated implant it would still osseointegrate about 95% of the time whereas the then acid etched implants had a much lower success rate if they lacked initial stability. So if you place a Tapered Screw-Vent and it continues to rotate, it just means that the bone was soft and you have stripped the threads. If you can go deeper or wider to gain initial stability, your success rate with non-HA coated implants will increase. Definitely bury a spinner for a 3 month healing period.

  • Dr. Danesh from Iran July 30th, 2010

    Dear Dr.VD
    As a rull , upon drilling in a D4 bone [very soft bone] after the first pilot drilling most specially in max. post. area , I try to expand the site in order to achieve a denser bone then inserting the implant.
    In your case since zimmer swiss plus is an one stage implant, so you couldnot cover the tissue over it, w/c can decrease your success rate, (a disadvantage of using zimmer.
    I suggest you wait for 6 months befor loading.
    GOOD LUCK.

  • vinamra dhariwal August 2nd, 2010

    how about the safety of drug regime of Ostoefos [Fosamax, alendronate; a bisphosphonate] for three months. has anybody tried it and any study related to this

  • Dr J August 3rd, 2010

    Don’t worry. It will work. As long as the implant wasn’t moving freely and you had some minimal stability it will osseointegrate. I have had that happened to me a few times with other implant systems and they all integrated, given there was reasonable amount of bone around the area. I’m surprised that the Zimmer implant was spinning. Usually they have very good grip and aggressive threads. So now the questions is whether your site was good to place an implant or maybe you should have staged it.

  • Dr N August 7th, 2010

    Backing the implant out and simply placing osseous grafting partials into the osteotomy site will ususally tighten this up.

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