Placing an Implant Near Metalic Foreign Body: What Does the Literature Say?

this metallic piece, if not titanium, will be encapsulated by fibrous tissue, if implant touchs this tissue so you will end with fibrous integration on at least part of the implant, moreover, the corrosion product of this metal may affect the implant surface. this may happen regardless which surface you use, and i think that HA coating is more sensetive to this and may resorb. good luck Hamza

If you are concerned, remove the foreign body.The surgeon should have seen it during the surgical removal, or he was the cause of it. It shouldn't be a major problem removing it after explaining to the patient that it will be easier removing the foreign body than replacing a failed implant.

Dr S: In theory, it could be a problem, however, I have seen several implants in my practice placed very close, if not touching a fragment of amalgam from an old apicoectomy, when someone still sealed the apex with amalgam back then and are doing fine. I don't have any reference for you.

Removing the cause of your concern will give you peace of mind. Simple, direct, effective! Well said, Dr. Berne.

Dr....are you afraid of the oral surgeon, or the Pt....? I, dont see the dilema, follow common sense, who did the ext. bone graft? and will perform the implant....? Note observation of forign body,and refer back!!!! let the surgeon make the decision of where the implant and object is going to end up!!!!!!

Chill, Dr. J.G.! One cannot/should not impose one's line of thinking on others! It is all a matter of perspective. There is no right or wrong answer here. Dr. S. made it very clear that he feels that the implant "will be doomed to fail," if the foreign body were to be left behind. Foreign bodies [implants included], are known to behave unpredictably at times, depending on different biologic variables that come to play. It would simplify matters, if one is able to minimize their presence in the equation. Why leave this decision, to elliminate a foreign object with your OS, when you have already made that decision? Simlpy ask your partner, in a nice way, to please remove it, period. It is of UTMOST IMPORTANCE that you DEFINE where you stand on SPECIFIC issues, to poster smooth communication lines.Being an EFFECTIVE COMMUNICATOR is a key ingredient to your success! Warmest Regards,

There is a very good chance that when drilling the osteotomy the"object" will be removed. Tell the OMS your concern and ask them to take a radiograph of the osteotmy before the implant is placed. That way the implant won't block you view of the "oject" if it si still there. Good Luck

Dr. S: I have had the same experience with a case and my implant failed. The most important factor is the patient safety and implant placement is a very important procedure, more than what the oral surgeon will feel. If you or anybody else is going to place the crown and the implant fails, whose fault is it going to be?

I agree with Dr. Nelson. The metal fragment will probably be suctioned out of the osteotomy prior to the implant placement. An x-ray will confirm that. Why complicate an already complicated procedure?

1)look at the history of the site. you have a pre-op xray. was it there before as a retrofilled apico from back in the day or does it only show post ext? why was the tooth ext.'d; failed rct,followed by failed apico? if so you're probably out-of-luck because that foreign body agitation/granuloma has been long established. if it's just a piece of metal(provided it's not ridiculously large)you've got to ask 2)how was the extraction? did it leave a 1,2 or 3 walled defect to graft or come right out w/ some luxating and periotomes (lookat the post-op xray,are the cortical plates that run down the root sockets intact or obliterated?)why this all matters is because you have to look at where the foreign body is located w/in the graft material.the immune reaction is slower relative to most irritations but it will mess-up an integrating graft material(especially synthetics)if it's in the core center of a large graft you're probably done because the graft didn't take. if it's along the interface of remaining bone and graft material you're probably alright provided the patient isn't 3)allergic to everything under the sun.i've seen implants work w/ shards of amalgam all around them but if the patient has alot of allergies usually the tissue (bone or soft) is hypersensitive to foreign bodies of all sorts.

Thanks for the advice and comments. Sorry I wasn't able to post here again but we had an after hours break in at the office so I have been a little pre-occupied. Maybe "doomed to fail" is a little extreme; but a little more background. Tooth #30 had been chronically inflamed. Prior endo, posts and core and porc to high noble crown. Suspected root fracture. There was a flare-up, the patient was placed on Amoxil. Because of this I would not surgically extract this tooth and place the graft at that time. The patient saw the oral surgeon, I do not know the state of health infection wise at the time of the surgical extraction and bone graft. The metallic object could be stainless steel (the posts) amalgam (core) or high noble white gold porcelain alloy as the result of sectioning this tooth. The patient related that he was on 5 courses of antibiotics with the need for culturing at least one time after the extraction and graft. 3 months post surgery the tissues look healthy. I have fabricated a surgical stent (guide tube and acrylic) and because of the divergent roots of #29 and #31 I have a good path of placement which should be well clear of the metallic foreign body, at least 3-4mm confirmed with a pa film with the stent in place. To remove the metal in the depth of the distal alveolus would require a fair amount of surgery in this grafted site. I still am hesitant due to the possible long term possibility of the products of corrosion but I have searched the literature and can't find a reference. Thanks again everyone