Repeated implant failure: causes?

More information about the patient is needed. Sex, health, habits, medications. A bone core for histological examination should be taken if another attempt for implantation is done at that site.

Sorry but to little info for an hipothesis. How about xrays pre and post, clinical history, brand of implant, type and length and a brief surgical protocol... bone graft or not etc.... Alex

Please post radiographs before treatment and at each failure to help along with info others have requested

Chronic localized osteomyelitis from previous endodontic failure perhaps. Curette bone for biopsy and definitive diagnosis.

This is going to sound like a wimpy answer but it is honest, I have had a few patient's where site specific implants have failed.There can many multifactoral reasons, infection, poor blood supply, you can do everything correct but still no integration. Multiple surgical interventions can take their toll. So I look at these logically when I don't have an answer, three tries it is not meant to be, consider the patient and change the treatment plan. These are elective, non life threatening dental procedures. Be grateful that so many implants work but anyone who has been doing this a long time knows that there are no absolute guarentees in medicine and no one ever died from a failed implant, just our egos can take a hit. thanks for posting.

Most probable cause is so that the patient is chewing on this area somehow.

Interesting issues. Like my colleagues have said more info necessary to rule out some of the usual suspects ie overheating bone/trauma/occlusion etc. What about medical issues, healthy patent or undiagnosed pathologies? having three attempts will require a detailed forensic analysis with the patient's overal heath in mind never mind the teeth at this stage. Share with us your findings, you may be surprised at causation. My principal mentor had a patient unscrewing their implant "at home" - an obvious failure from a very unlikely cause. My personal experience with odd patient factors was with a symphsis graft. Here complications resulted from patient going shooting immediately into healing and trauma from the stock of the gun recoil affecting my grafting!

That's something not very usual but we all know about similar cases. As the others colleagues posted, it would be wonderful to have an X-ray. Maybe if you monitorize the implant with an Osstell you may have more information about the situation of that implant at the beginning and afterwards. What I would avoid is placing the healing abutment the very same day of the surgery. One cause could be that "immediate loading" over that healing abutment.

Hi CRS , great , it can happen the more you do and the more complex the case , failure will happen , no one dies but in this medico-legal world just take responsibility and re-do for free . It is a 1% situation so rare . As no information we have to generalise , only once in 24 years have I had a case where failure has happened twice but I generally have 3-5 pre loading failures a year. So maybe need to think about it and change something in the protocol , as it is most often granulation tissue ( often post infective ) time is a good heal along with site preparation .. Peter

This thread has been interesting. Yes, patients do some unusual things. They have unusual habits etc. Many times we don't realise there is a habit or activity that causes failure or some sort of complication , till after the fact. I have one patient that constantly clenches his teeth and had to perform an explanation two days ago. He flew in from Alaska to Virginia for treatment. Another patient has a habit of sucking on his lip. This causes sutures to come lose and the wound to open. We all could benefit from exchanging this kind of information. Yes, suck it up and do it over. It's not worth the grief.

The point of this thread is to try to identify just what might be causing this implant to have failed THREE times...otherwise you will just be doing the same thing and expecting a different result (aka definition of insanity). This is why it would be very beneficial if we could have more clinical information

Alex Corsair is on the right track. The repeated failure in the same sit has nothing to do with implant brand, length, surface or surgical technique. It is most likely due to a persistent bacterial biofilm in the bone that developed when the tooth was still in place. Until that collection of pathogens is removed, subsequent implants will continue to fail. Close examination of your by now large collection of radiographs should show a faint area of sclerotic bone, which is where the node of bacteria lies. This area also has a severely compromised blood supply, and until extensive surgical curettage is carried out, and a channel made from the adjacent healthy bone to the sclerotic area, to encourage development of a normal blood supply as healing occurs, the site will not be ready for an implant. Bacterial sampling of the sclerotic area will show up the pathogens present. The sampling however, is difficult technically, as the accidental collection of other intra-oral organisms needs to be avoided. Six months later, a radiograph should demonstrate a normal cancellous bone profile, and if you want to be certain the site is ready, further sampling needs to be done to confirm the bone is clear of pathogens. If so, then you can proceed. The problem is that you have already mounted a number of surgical interventions, and only the most durable of patients would be prepared to go through these further procedures, and these procedures are technically demanding. For references please look up the published work by Stephen Nelson et al, who has done some ground breaking research on the bacterial biofilms in bone, research which challenges our long-held view that bone is sterile. In this case however, I would be exploring other replacement options

One thing you did not explain was whether the implant placement was in a grafted ridge, a healed extraction site, or extraction/immediate placement. Each one of these conditions may have a completely different biologic response. RJM

http://www.researchgate.net/journal/1708-8208_Clinical_Implant_Dentistry_and_Related_Research