Osseo News Logo

The Original Dental Implant Community

Sign In

Failure in distal implant: suggestions?

Last Updated: Jun 21, 2018

As you can see on the radiographs, I placed two implants in this patient. The bone is unfortunately D4. One month later, the distal implant was about to exfoliate without any pain, just inflammation of the gingiva around the implant. The mesial implant is okay. I am wondering why did this happen? I am planning on replacing the distal implant in three months. What are your recommendations?




27 Comments on Failure in distal implant: suggestions?

Richard Hughes DDS

06/21/2018

The tongue killed the implant. I understand why you placed the healing abutment but the tongue is the culprit. I have been burned this way. So now I don’t place a healing abutment at the time of first stage surgery.

HARARI

06/22/2018

You never do one stage surgery on the posterior lower teeth ?

Dok

06/22/2018

Always consider all the usual suspects and revisit patient's medical history, the treatment plan, surgery and post-op circumstances. Avascular necrosis( not enough good bone around the implant ), pressure necrosis ( over torquing the implant in dense bone ) and necrosis from trauma ( including tongue forces ). Don't make the same mistake twice. If you are unsure, always refer.......

Elvert Pinzon Ferro

06/22/2018

inminente infeccion en la ensercion en el momento de la cirugia. IMPLANTE CONTAMINADO.

Harari

06/23/2018

Contamination from Salive is possible?

Dennis Flanagan DDS MSc

06/22/2018

Was #31 a failed endo? If so there may be vegetating bacteria in that site.

Harari

06/23/2018

I don’t know The patient has left these two teeth long time ago before I knew her

mwjdds,ms

06/22/2018

Sometimes bad luck. My suggestion is don't try to find a reason. Failures happen to good people. However, #31 has serious mesial drift make sure you remove the mesial aspect of this tooth to parallel your implants otherwise you'll have a food trap. Let it heal and redo it or, if all else fails connect the implant to the natural tooth as a three unit bridge.

Harari

06/23/2018

I cannot connect to the last tooth It’s a little bit shaking

Dale Gerke - BDS, BScDent

06/25/2018

Are you really recommending attaching a fixed prosthesis to an implant and natural tooth?

mwjdds,ms

06/26/2018

Sorry, I was out of town. Yes, I have connected teeth to implants for over 20 years. It's not my first choice but has worked very well when connecting to aperiodontally stable tooth. I also use a semi precision attachment on the proximal surface of the natural tooth.

Marcusdoc

06/22/2018

I’ve posted many replies and have seen many other people reply to these posted cases. I have yet to see a response from the original poster. Am I correct on this? Why is there never an identification of the poster and yet the repliers have to identify themselves? It would be nice to hear the OP respond to some of these very good recommendations and suggestions.

Harari

06/23/2018

Sorry but I was not able to re-ply at the moment

amahmud1986

06/22/2018

I would suggest doing two stage surgery and letting the implant stay completely covered with soft tissue for a minimum of three months, possibly longer depending on the degree of initial primary stability and the quality of bone in the area. Also, it will be challenging to restore these two implants due to the mesial angulation of the second molar as mentioned by previous commentators. For the failed implant, what size did you place? Did you use a pre-op CBCT to verify accurate bone depth before your osteotomy?

Harari

06/23/2018

It’s your last question you got the answer on the x-ray I post at the beginning

DREAM DDS

06/23/2018

I feel all these replies are possible and excellent and could be true for any case at any given time If true D4 bone it is not good to place healing abutment. True D4 bone would not allow torque above 25ncm and that contraindicates healing abutment. What were the individual torques Tongue and food even soft food creates sheer forces. Wait until you see the same case, implants covered 4 months , uncover and have the same result Molar screws out. Some things just do happen I like the foresight to Tx plan the molar for plasty or crown. That is forward thinking.

Harari

06/23/2018

Thanks for your answer When I began implants 30 years ago, I only used two stages surgery. But several times, I found operculisation and the food went into the hole, and then loss bone. So I used one stage to avoid that problem.

Raul R Mena

06/25/2018

There is something wrong with the XR . Compare the position of the apex of the failing implant and the incisal portion on both XR. Either distortion or the implant was extruded due to the infection

Harari

06/25/2018

Thats’patent Extruded.

Harari

06/25/2018

40 Ncm at the last screw Certainly because of the thick cortical bone.

Oliver Scheiter

06/23/2018

The other implant seems to have the same kind of problem just not as advanced. My bet us you overheated the bone. With an aseptic inflammation you don’t need to wait three months. You will have to remove the inflammatory tissue, though. Watch the other implant closely

Harari

06/23/2018

Alright

Don Callan

06/25/2018

Remove IP, remove soft tissue, Graft with an allograft, wait 3-5 months , place another IP, wait 3-4m, restoration

DOCTOR SM

06/26/2018

Some implants are in a sterile bottle with sterile saline in.This causes failure, not in every piece though, because of salts on the implant surface. I lost 1 out of 4 , 2stage implants with no other complication,the implant company stopped the sterile water in the bottle.

DREAM DDS

06/26/2018

I am interested in the implant brand used here and also the implant in saline mentioned by DOCTOR SM often there are issues we never hear about and the companies bury the truth. Thanks Leonard

Neni Shriver

10/23/2018

I wish there are Pano, BW, PA, CBCT provided here. Judging from limited xray, I wouldn’t hesitate to remove #32. Remove implant #31, bone graft wait at least 4 months. Place implant #31 with full thickness so you can see well ,burry it for 4 months.

Harari

10/23/2018

Thanks for the answer You took four months of reflection ! Must be a wise man

Featured Products

DALI Bone Mix

DALI Bone Mix

The highest quality tissue!

Classic

Classic 50/50 Mix

Promotes osteoconduction

Provides structural integrity

DALI Bone Syringe

DALI Bone Syringe

Prefilled Mineralized Cortico-Cancellous Bone in Syringe

New

Convenient Syringe!

50/50 Cortical/Cancellous

Available in 3 sizes.

Osteogen Plug

Osteogen Plug

Combines bone graft with a collagen plug.

Classic

Eliminate hassle of mixing particulate grafts

Sold in packs of 5 or packs of 10.

Proven safe, and clinically effective

OsseoSeal Flexible Membrane

OsseoSeal Flexible Membrane

Resorbable collagen membrane derived from purified porcine pericardium

Popular

Fast hydration and excellent tensile strength

Good adaptation to various defects

Excellent tear function and duration

DALI One Graft

DALI One Graft

One-Step grafting solution!

New

100% allograft

Eliminates mixing hassle

Moldable after hydration