Dental Implant Failure after 8 months: Your Thoughts?
I placed an implant to replace tooth #14 a year ago. It was fully integrated with an ISQ value of 82 at the time of the loading. The crown placement was 5 months ago. Everything was perfect with this implant, no bone loss or any sign of failure. I had the patient for a regular cleaning yesterday and her complaint was that she noticed mobility in that implant- crown for a week. Initially, I thought it is the screw. It was unfortunate that the implant and crown were mobile in all directions and there was nothing wrong with the screw. The implant came out so easily without any resistance and the surface of the implant has no bone! The site was curetted and it was packed with fibrous tissue and the implant was encapsulated. Sharing your thoughts about this case would be greatly appreciated!
27 Comments on Dental Implant Failure after 8 months: Your Thoughts?
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Dennis Flanagan DDS MSc
4/10/2019
Could be any number of reasons: off axial loading, patient bite force capability (did you measure this pre-operatively?), failed endo site with vegetative bacteria colonizing the implant, foreign body reaction etc
Richard Hughes DDS
4/10/2019
Dr Flanagan took the words out of my mouth.
PerioProsth
4/10/2019
I am not certain on what i cam going to tel you, but it is the best i could come up with.
Your High ISQ could mean compact bone with less spontaneous bone. Do you remember how dense the bone was at the time of implant placement? Was it Type II and very dense?
your ISQ 82 was at the time of placement or at the time of uncovering?
what speed you were using at the time of osteotmy? Are your Drills sharp ? was the irrigation adequate?
I am thinking of possible over heating the bone and causing necrosis, which lead to total bone resorption all around the implant.
Graft it and let it heal well and start over in 6 months.
Good luck.
Geoffrey Pullen
4/10/2019
Take a look at the lecture ‘Implant design and related bone response ‘ by Paolo Coelho on the Bicon website. You’ll find some of your answers there.
PerioProsth
4/11/2019
i will take a look. thank you.
Timothy C Carter
4/10/2019
Bad luck
Neil Zachs
4/10/2019
Implant looked fantastic at pre-load film. I agree with Dr Flanagan....looks like either a load issue or maybe the site was not debrided well post exo and it’s a bacterial issue. But I would lean more to the occlusion aspect based on the excellent integration pre load. Looks like a surgical success and a failure from the restorative/occlusion aspect
Neil Zachs - Periodontist,
Scottsdale AZ
Implantesyestetica
4/10/2019
Hola la implantologia acepta esta pérdida como mediata; aproximadamente al año de implantar . Pienso que la integración en un 20 o 30 % de la superficie de implante da un falso positivo y en ese tiempo se cae. En mi experiencia de 20 años me paso 2 veces ; en los 2 casos reimplante a los 6 meses con éxito. Buena suerte
Dok
4/10/2019
Avascular necrosis ( not enough bone in one or more dimensions ), pressure necrosis ( over torqued ), occlusal overload necrosis ( too much biting force ), temperature necrosis ( overheated bone ), poor oral hygiene/cement induced peri- implantitis, or plain old allergy to one or more of the implant alloy components. Think it through from the beginning. Yes, do the case again but don't make the same mistake twice.
Tim Hacker DDS, FAAID
4/10/2019
Dr. Flanagan is correct. Sometimes there are forces in place that we do not expect. So you'll get it right next time. Graft, replace and go more slowly on the loading process by longer provisional and out of occlusion before placing the definitive restoration. Make sure the soft tissue has adequate keratinized tissue attachment around the implant.
Greg Kammeyer, DDS, MS, D
4/10/2019
When you remove the implant be sure to be aggressive with a dental curette and especially a round burr to clean out any residual bacteria that are in the bone. This is especially important with failed endo teeth.
FFD
4/10/2019
What about medical history. Is the patient diabetic, cigarette smoker?
Could be combination of things but I put my money in occlusion and pressure necrosis
I am investing in the sonic device you use to determine stability prior to loading
After seeing these cases you would be glad to pay the money to get one
Gregori M Kurtzman DDS
4/10/2019
I would concur with Dennis Flanagan, often this is an occlusion issue that lead to this and happens in mixed dentition cases mostly (natural teeth with some implants) IMHO we need to have the implant crown slightly out of occlusion so that it doesnt come in contact until the natural teeth bottom out in their PDL. Otherwise the implant receives increasing occlusal loading as the teeth bottom out in their PDL.
Another thing that can lead to this is undiagnosed diabetes or other metabolic issues. When did the patient last have any blood work done? Any family history of diabetes?
Dr. Gerald Rudick
4/10/2019
Could be an improperly contoured crown in relation to the diameter of the implant, which led to a food trap that brought on peri-implantitis...as well as all the other explanations given above... we have come along way in our chosen profession, but we have not yet received the status as "GOD"
Nolan
4/10/2019
Thank you all for sharing your thoughts!
To answer few of your questions;
- there was a failed RCT on that tooth, bone graft was placed 4 wks after exo, no infection exists and the site was fully excavated prior to grafting.
- No medical issue, pt is healthy.
- No occlussal contacts, the occlusion on the crown . shim stock passed easily at the day of placement
- screw retained and not cement retained crown
- Oral hygiene is optimal, no perio disease.
- My only thought that it could be a reaction to foreign body, how often would such a reaction could happen? I am now worried about other cases.
Thanks a gain!
Mohammad Alahmad
4/11/2019
Thanks for sharing your case doctor
I am going with Dr,Dennis Flanagan , ( Loading is first cause of later _ Prostho- complication ) the implant diameter as i thought from photo like less than 4,5 which is consider to be in this site.
Dr.PerioProsth mention a good issue that the type of bone as you got this ISQ rate also responsible for late failure.
all the previous reasons should be considered, for my side I am not agree to to graft the site at the time of implant removal as there is a high active of Osteoclast cells now .consider a period of 3 weeks to re entry for grafting at lees , or delay every thing ( grafting + new implant ) for a period of 3 months
Bruce S. Fine DDS
4/11/2019
Hello all! Having been involved with implants for 30 years, I would like to share with you something I discovered many, many years ago. Anytime I do an extraction and am placing either a bone graft or immediate implant placement or both, I place minocycline in the extraction site. Years ago it was tetracycline but that has become less available here in the US. The reason is twofold. One, it's an antibiotic. Two, it's Minocycline HCl. The HCl is amazing in its capability to clean the socket. We open the capsule and mix the hydrophobic powder with drops of either sterile water or anesthetic and mix it until it becomes a very thick paste. It is then placed in the extraction site for about a minute after the site has been curretted. The site is rinsed and then the site is curretted again. Any remaining soft tissue is loose and comes right out leaving a clean site. Let me know if you have any questions and I would love to hear your results. Thanks
Nolan
4/11/2019
Thank you for sharing this advise. Greatly appreciated!
Bill McFatter
4/11/2019
Was this flapless/tissue punch/ guided? Your placement looks good- sometimes if you are not careful you can trap soft tissue in the osteotomy. Any metal allergies with the patient?
While I know it is controversial- I had a patient that had the same thing happen. I was so proud of the implant -dodged root and impacted bicuspid only to have the pt loose the implant exactly like this She was a librarian and she brought me all of these medical articles about rejection of titanium hip and knee replcements theorized to be allergies to the Ti-don't know- she had metal allergies
Andy
4/11/2019
The bone loss around the implant appears way too symmetrical for either occlusal overload or periimplantitis. I'm in the osteotomy complication camp here
Igor
4/11/2019
If patient smoker ......
motaz tayeh
4/12/2019
i think its occlusal overload .
the length and diameter of the fixture appear small in relative to the crown
Peter Fairbairn
4/13/2019
Implants do not fail the host tissues do , here in lies the problem we are not placing into a block of wood but living tissue , so many factors play a role . They are mentioned above , but Vit D , Cholesterol etc ,
Periokongen
4/18/2019
The radiolucency is way to symmetrical and homogenic. So I'm thinking the following are more likely: a body reaction to the metal, loading issue, contamination during placement, unresolved endo issue (higher risk of failure when implants are placed immediately after ex).
Aakash
4/19/2019
Yes there is a high possibility of contamination via touch or exposure, which results in loosening, similar to what we see in spine surgery/orthopedics.
1. Agarwal A, Lin B, Wang JC, Schultz C, Garfin SR, Goel VK, Anand N, Agarwal AK. Efficacy of Intraoperative Implant Prophylaxis in Reducing Intraoperative Microbial Contamination. Global spine journal. 2019 Feb;9(1):62-6.
2. Eren B, Güzey FK, Kiti? S, Özkan N, Korkut C. The effectiveness of pedicle screw immersion in vancomycin and ceftriaxone solution for the prevention of postoperative spinal infection: A prospective comparative study. Acta orthopaedica et traumatologica turcica. 2018 Jul 1;52(4):289-93.
3. Leitner L, Malaj I, Sadoghi P, Amerstorfer F, Glehr M, Vander K, Leithner A, Radl R. Pedicle screw loosening is correlated to chronic subclinical deep implant infection: a retrospective database analysis. European Spine Journal. 2018 Oct 1;27(10):2529-35.
4. Agarwal A, Schultz C, Goel VK, Agarwal A, Anand N, Garfin SR, Wang JC. Implant prophylaxis: the next best practice toward asepsis in spine surgery. Global spine journal. 2018 Oct;8(7):761-5.
Ken A
4/28/2019
Excellent comments. Thank you to all. I find it very time consuming and laborious to debride a large fibrotic socket during extraction. Any comments on powered debridement with ultrasonics or rotary instruments. Diamond or carbide? Any sources for RA slow speed diamond or ss surgical burrs long enough to reach the base of a molar socket? The knowledge and experience passed on here is very appreciated. Thank you.
Pinard A. Cunha
7/6/2019
Checar a oclusão e a cinética dos movimentos em desoclusão canina( guias laterais e desoclusão incisal. Mesmo um implante bem conduzido cirurgicamente e a p´rotese bem executada esteticamente, se o trauma oclusal existir poderá levar à falência do tratamento reabilitador.
