Re-implantation in the same site that failed?

In this case, the implants were installed 4-months ago. Radiograph shows bone loss in the coronal region. My protocol in cases like this is to explant the implant. If there is no infection, and I find only hard fibrous tissue around implant,
my question is: Can I place another implant in the same site? The ridge is narrow and I originally used a 3.75mm, so the replacement would be 3.5mm or 3.75mm. I cannot use a wider implant. This site is the best choice, because of the proximity of the mental foramen, it is risky to go mesial.


13 Comments on Re-implantation in the same site that failed?

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yalda sadeghi
12/8/2015
please explain more about your reasons for explant.
Dr. Alpha
12/8/2015
Hi, Thank you for your answer. I believe there is a progressive bone loss on mesial (right) implant. When implanted, it was slightly below the surface of the bone, now the bone is gone in about 2-3 mm. Also, around the implant, the bone is less dense than before. I think it will get worse. note - this is 3.5mm inside, so I can only re-implant 3.5mm or 3.75mm implant in the same site, because the bone is too narrow for 4.2mm implant.
drt
12/8/2015
"I believe there is a progressive bone loss on mesial (right) implant." What is your diagnosis as to the cause of the bone loss? What will be different if you explant and place a new implant? How will you prevent the same thing happening again?
Gregori Kurtzman, DDS, MA
12/8/2015
it appears the mesial implant was not placed deep enough when inserted thats why there are threads exposed. Do you have a radiograph showing implant at placement?
Jaime Ramos
12/8/2015
Could we have some views on GBR material ?
Adibo
12/8/2015
The left implant is at the level of crest. The right implant seems it has been placed superficially as Dr Kurtzman described above, and the story of "bone loss" does not add up I am afraid! Otherwise the left implant would have been 3 mm below the alveolar crest at the time of the placement! If you have to explant the implant of any reason; position or angulation, you can perhaps place a shorter implant similar and parallel to the left implant (if in correct position). The new implant should engage partially in to newly prepared bone.
carlos boudet
12/8/2015
You could also have placed the implant in a site where the bone width was narrow at the coronal part of the implant and by eliminating the blood supply to the area you caused the coronal bone loss. Without pictures and x-rays of the surgery it is only a guess. If there is enough bone to go deeper, you may be able to use the same length implant, otherwise you may need a shorter one. Good luck!
Dr. Steven Kollander
12/9/2015
you can definitely place an implant at the same site but not the same day. If you are contemplating placing an implant at the same site, I'd wait about one month prior to re-entry.
Dr. Alpha
12/9/2015
Hi, Is there any specific reason to wait? I made the hole wider (from 3.5 to 4.2), because after this coronal bone loss , the bone was wider at the top. Why not re-implant immediately?
Dr. Alpha
12/9/2015
Hi everyone, Both implants were placed 0.5-1mm below bone level. Coronal bone loss definitely happened. I think dr. Boudet is right, it was either too narrow bone or maybe occlusal pressure. I opened it up yesterday, definitely bone was disappearing, and some hard fibrous tissue replacing it. No infection (no pus), actually no fluid at all. i removed the implant, fibrous tissue was growing around it. i placed another one, wider, made a bigger hole and placed a 4.2 implant in the same place. We will see after 3 months. Thank you everyone.
GB oral surgeon
12/18/2015
Good topic . Going back to vaducs the blood supply to the crest of alveolar bone us from periodontium and if the implant was placed in immediate extraction site you are bound to lose the crest early on . If the implant was placed in healed healthy bone then the bone loss is dependent on the thuckness of bone st the region of the neck of implant . Going by mechanics if this bone at crest was very thin it is bound to resorb. As regards explant and implanting let's not forget physiology . You are placing implant in remodelled bone with skewed healing response . I would wait for good 3 months before re entry . Possibly I would graft ramus or chin bone to gain width at that stage .
GB oral surgeon
12/18/2015
Sorry typo I meant basics instead of vaducs!!!! Auto correction
DrTimMillerDICOI
12/30/2015
That's why the guideline is to have 2mm bone buccal and lingual. Would have been a good idea to plasty the ridge to get more width and also allowing you to place the implants at the same level (height).

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