Astra Implant Rotated after Retorquing: Prognosis?

I would say that you did not wait long enough for integration. 2 months in D3 bone is not long enough- I would have waited at least 4 months in that sitiuation. You could leave it alone for another 6 months (now you have to start over with integration, because you are back to day 0), and pray- or take it out and place a new one in the next larger size- and wait! BTW- Radiographs are not a good indication of osseointegration- think about it- the day you place the implant and take the film- it looks no different than when it is integrated. Good luck!

Just a thought, if you used the plastic driver that comes in the Direct Abutment API kit rather than the hex bit to torque the abutment, it has a tendancy to slip/strip giving you the idea that your abutment and/or the implant may be rotating. Ideally, you should use the hex bit in conjunction with your torque wrench or if you happen to be working with DA 4's (the narrowest of Direct Abutments), there's a specific DA 4 metal carrier you'll need. Otherwise, I would contact your local Astra representative and request to speak to with their Technical Advisor for further instruction. They will be able to point you in the right direction. Good luck!

First, I agree with above comment that 8 weeks might have been too short a time for adequate healing. I would recommend 10-12 weeks if you are not fully convinced that your dealing with D2 bone. Secondly whenever possible you are better off prepping Ti out of the mouth, use an implant replica in a grinding handle. Easier and best not to inadvertently heat the bone, which might possibly have been a factor. All that being said I would wait another 8 weeks and re-test (re-torque) the implant at that time. Best of Luck

Upon retorquing the abutment again after the said period, think of using some anti-rotating device like custome made acrylic jij to prevent rotation of the fixture.

Just wait longer....another 8 weeks. Most likely it will be fine. I've had the same experience. Time is your friend in these situations.

This happened to me several years ago on an Astra at # 8 site. You basically micro-fractured the immature peri-implant bone. I waited 12 weeks and the case worked out fine. The implant will reintegrate. Put the healing abutment back or the DA snap cap and make sure there is no occlusal interference.

Ditto the above. You did not wait long enough. You have broken any bone-implant bond. Chances are that it will not re-integrate, but it might. You didn't say what you did after. If you continued to place the restoration, you're going to have a failure since there will be micromovement preventing any re-integration. If you were able to take the abutment off without further moving the implant (probably doubtful), and burried it, you have a small chance of re-integration. Removing the implant and replacing it with the next size larger is a great option - if you have the bone to do so. Your safest bet is to remove the implant, graft the site, allow for 4-6 months healing, place another implant in the site and wait 4-6 months. I know it's not what the patient or you want to hear, but leaving it in can create additional bone loss.

Was the abutment in the mouth while adjusting? I wonder if heat could cause the problem if that was the case.

What are the major questions GPs face while dealing with implants and implant restoration. I own a dental laboratory and set up CE courses for my general dentists and I need feed back on what topics GPs are looking for. Do you see an introductory course would be more helpful or a sales and marketing to patients, esthic solutions or custom abutments? Would you think a program about osseointegration and the problems listed above would be the most helpful? Any help for me would be great.

I acquired an abutment holder to try to prevent the above experience and hope it will keep me having the problem. As others have mentioned a waiting period of at least 3 months, and depending on the bone quality, even 5 months makes for a more secure feeling than the risk of having to start over. I do think we are tooooo anxious to get the restoration in. Telling the patient "their" situation requires "we need to wait another month" is usually our problem and not his/her's.

This is where getting a baseline ISQ with a radiofrequency device like the Osstel Mentor can give you that added piece of mind to better predict proper integration.

Forgot, then at time of uncovering, another reading is taken and base on comparison and actual raw value, it can be determined if things need a little longer to simmer or the fixture is torque ready.

I was told by my astra rep that with the new osseospeed surface, integration and restorative work could be done in a month or less, regardless of type/quality of bone. are others getting this same type of result?

I place Astra implant and love them very much over 3i, nobel biocare, and biohorizon. However, I still wait for at least 4 month in D3 bone, especially in the posterior area. If the tooth in the anterior than you can restore it early or even in the same day (if you can torque it to at least 25Ncm). I have several case where I place implant same day and torque the implant and place the abutment and crown the same day (I have a Cerec). Anterior teeth can be adjust such that it is free from the occlusion (eliminate micromovement). However, on posterior teeth, especially the first molar area, at least four month waiting please. The final restoration on the first molars should have good occlusion NOT light occlusion like other areas.

The comment, "I was told by my astra rep..." concerns me. It seems as though more and more dentists are relying on the word of their sales reps instead of evidence based literature. Most dental sales reps have little more than an undergraduate degree and, unless they have a doctorate in medicine or dentistry, they are definitely not qualified to be giving out medical/dental advice. This question can be answered best with a combination of the literature and experience. For starters, read Raghavendra (2005) in IJOMI. This article provides a great review of wound healing around dental implants. When placing an implant, primary stability will initially DECREASE during the first 2 weeks. Stability of the implant will not reach "baseline" levels until approximately 8 weeks as newly formed osteoid begins to integrate around the implant surface. Many companies and clinicians are trying to speed up this process of secondary stability through innovative new implant surface technology such as 3i's nanotite surface. Others have tried coating implants with PRP and have shown promising results. Zechner (2003) found that implants placed with PRP had increaed bone-to-implant contact (BIC) in early wound healing compared to controls. Over time, the BIC between the 2 groups was similar, but this study does seem to suggest that PRP may speed the early wound healing process associated with implants. Most of the more current PRP studies seem to be showing similar results...that PRP speeds the initial wound healing process, but over time, the end results are similar. Personally, I have used PRP on immediately loaded implants with success. Was it the PRP that gave me the edge? I cannot say for sure, but I do have lit to back my treatment rationale. More to the point of this question, I have had implants that were slightly mobile at 1 month. This seems to be directly related to initial torque values at the time of placement. Whenever I have had this happen, the initial torque was always less than desirable. Ottini (2005) is a great article to read to understand how initial torque value relates to implant success. Anyway, my experience with mobile implants has been to allow more time for healing. In most cases, the implants tightened up and were restored without incident. Now, I am talking about very minimal movement early in the wound healing process. If your implant is 2 months out and is moving quite a bit, it is likely a failure. On the other hand, if you can put some torque on the implant and you are only getting extremely minimal movement AND it is early on in the wound healing process, a little time and primary closure may be your best bet. Hope this helps.

How can you tell that the "osteointegration on the x-ray looks good"? I've never seen anyone able to determine the degree of osteointegration with an x-ray. How do you do it?

hello colleagues! i think that we have to listen many different scientific and rational opinions and have the mind to look the "wise" way to resolve this injury that can happen. i would like know if you have different outcames during the osteointegration recovery (without occlusal loading) with or without antibiotic therapy. Thanks and sorry for my poor english FdF Rome Italy

I have experienced this several times. I changed the cover screw to healing abutment with 4 mm height ( not interfere with occlusion ) and use it as a intermediate loading for 4 weeks. it helps osteintegration to be faster and guided.

I think it will osseointegrate.Can temporise it and wait

I am a customer who recently had an implant (Astra) done. I think the Dentist who did it is very good but there is very poor communication between us and all of my questions remained unanswered. Basically I would like to know in order the following: 1. how is the ossointegration verified and established (apparently the only think the Doctor has is a set of x-rays and visual inspection)2.what kind of torque (Ncm) can be applied safely after three months of healing without compromising the integrity of the implant and possible rotation of it under the applied torque 3. what is preventing the rotation of the crown once it is set in place over the implant 4. Who is deciding on what kind of thread is the right one for the implant exterior surface and interior surface ( M 1.6 or else) in order to have an even distribution of stress (I asked this question to Astra without getting any intelligent answer) 5. What is insuring the sealing of the line gums/implant to stop any kind of infiltration ? I would appreciate an asnwer to my questions thanks