Failure in distal implant: suggestions?

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 thoughts on: Failure in distal implant: suggestions?

  1. Richard Hughes DDS says:

    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.

  2. Dok says:

    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…….

  3. mwjdds,ms says:

    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.

  4. Marcusdoc says:

    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.

  5. Anon

    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?

  6. DREAM DDS says:

    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 says:

      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.

  7. Oliver Scheiter says:

    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

  8. Don Callan says:

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

  9. DOCTOR SM says:

    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.

  10. DREAM DDS says:

    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.

  11. Neni Shriver says:

    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.

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