Drilled Too Deep when Preparing Hole for Implant Insertion: Should I Be Concerned?

Dr. F. asks:
When I finished preparing a the hole for the dental implant insertion, I found that I had drilled 2mm too deep. I am not sure how this happened. The digital radiograph I took to confirm that I had inserted the implant fixture to its full depth clearly showed a 2mm space apical to the implant fixture. I am assuming that this will fill in with bone. But I am concerned that it is a potential source of blood pooling which might lead to infection. I prescribed amoxicillin 500 mg qid. How concerned should I be about this empty space I created at the apex of the implant fixture? Any recommendations on how to better control the depth of the bur?

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22 thoughts on “Drilled Too Deep when Preparing Hole for Implant Insertion: Should I Be Concerned?

  1. Why are you prescribing antibiotics? Amoxicilin is usually 500mg TID – why are you using it QID? Obviously you need better control of the drill. Go slowly, 4-5 mm at a time, and take more x-rays as you go. Make sure they are scaled correctly. There are guide pins that have notches on them that you can see on the x-ray. The key is slow down and take lots of check films. I am a little bit concerned about your rational for the infection scare. This 2mm of over – preparation was a mass of fibin and platelets three minutes after you placed the implant. I see a lot of newbies throwing antibiotics at their surgical short-comings. I don’t mean to be rude, but for the patient’s sake be careful. Remember that antibiotics are not harmless. While the allergic reaction is rare, the rate of diarhea and nausea can be as high as 60-80%. Why did you choose amoxicillin? Wouldn’t you want an antibiotic that is better for anearobic bacteria with proven penetration into alveolar bone? Clearly Clindamycin would have been a better choice, but I still don’t think you needed one. The space will fill up with bone and radiographically dissappear in 2 years.
    Read, listen, and ask someone you trust while the patient is still in the chair. Good luck.

  2. It is like an extraction socket and surrounded with bone. It will be healed and filled with bone.Additionally, blood clot is in the extraction socket, isn’t it? It will be resorbed within a week.
    The clot is not in a soft tissue to result in potential hematoma and infection.
    Don’t worry.
    Neda Moslemi

  3. Dr. F, Check out the Anthogyr Mont Blanc Control handpiece. It is designed precisely to eliminate this problem. It is a 20:1 handpiece with a an adjustable depth stop allowing you to set the maximum drilling depth.

  4. YOU MOST LIKELY WILL NOT HAVE A PROBLEM IF IT WAS A STRAIGHT WALLED IMPLANT BUT YOU MORE THAN LIKELY WILL IF IT WAS TAPPERED. TAPPERED IMPLANTS HAVE NO MARGIN FOR ERROR IN THEIR POSITIONING.

  5. What is the implant site? Popping into the sinus=no big deal,been doing it for a decade.Perfing lingual cortex in 2nd molar implants=usually the result of not appreciating lingual anatomy and the mylohyoid ridge. Perhaps lingual hematoma or damage to aberrant lingual nerve. 2mm extra into the IAN= start referring out again and call your carrier.
    The space you created is of no clinical significance otherwise.

  6. If you had the bone availability to drill 2 mm deeper, perhaps think of using a longer implant. Also, drilling slightly deeper is normal practice in parallel walled implants as this give you the freedom to adjust implant depth. Do not do this with tapered as you only engage the implant towards the end of the osteotomy.

  7. Don’t worry about the space, it will fill in with bone. However, you should make sure that your drill lengths are exactly what you think they are, particularly around vital structures. Also, most drills are a little longer than the implant due to the pointed part of the drill, but not 2 mm longer.

    Antibiotics are rarely needed for procedures not involving a graft. If in doubt, just use a single dose, such as 1 gram amoxicillin an hour prior to the procedure.

  8. try to use guide, like ortho e chain to prevent working over the intended depth. use a cotton plier to widen the elastic and as carrier to be placed around the reamer. good luck.

  9. Gum Guy makes a good point when he mentions that a tapered osteotomy for a tapered implant could cause a problem.

    I would place some particulate graft material into the osteotomy prior to inserting the originally selected implant to act as a vertical stop and to backfill the walls at the crest of the ridge.

    I see no reason to criticize Dr. F for his choice or frequency of the antibiotics he presecribed.

    Gerald Rudick dds Montreal

  10. This is a surgical defect, not a pathological defect, it should fill with bone. Should not be a problem. Again, there is some good advice from the above comments. Pay attention to details during the surgical procedure.

  11. in order to avoid this particular problems you have to use CBCT with or without guide…conventional radyographic technics are not always sufficient for implant planning…But I don’t think you’ll have a problem in this case…Good luck

  12. Pardon me, but CBCT has absolutely nothing to do with Correct implant osteotomies which have been around for damn near a century now. That has to do with deliberate hand skills. I have intentionally backed up several implants to be safe and the radiolucent apical portion of the osteotomies all filled in fine. ALot of great advice in the above comments. Bill

  13. Having 1 or 2 mm extra depth to your implant is okay provided it did not traumatised any vital structures like the sinuses or the idn or the linqual or labial plates. Even so, if the implant does not impinge excessively into these structures, the body’s unrivalled healing abilities will cover up our misdemeanour. Of course we should rely primarily on our skill and foresight via thorough treatment planning to avoid these misdemeanours and only rely on the bodiy’s built in smart healing powers as a failsafe device. If in doubt about sterility, it does no harm to cover the patient with antibiotics. Might be helpful to also advice the patient to take some yogurt for those few days and some days after to replace any good bacteria in the gut that may have been destroyed.

    Cheers.

  14. Even in tappered implants a little deeper osteotomy is of no significance.As long as soft tissue is away from the area the clot will morph into bone.As long as there is primary stability at the top or bottom and soft tisse is kept away your implant will integrate (providing no pressure or thermal necrosis).
    Its important to be precise when creating implant osteotomies,as important as root canal length measurement and following obturations.If its sort or long it works.Relax and attend more courses.

  15. Dear sir, as I understood from your message , that you did over drilling with 2mm , you can put longer implant with same diameter and this will be more better for mechanical stress distribution , it is mandatory to use drills with stopper , thanks good that you didn`t injure vital structures. there`s no problem with the gap, it will be heal

  16. Expect no consequences from this, it is not a crown margin. In tapered implants it is more concern as mentioned. Realize that the drills are longer than the implants.

    I have clindamycin for injection, a few drops of this is handy in a situation like this, if you are really worried about infection.

  17. Great posts all. Go back and read Dr. Joseph Kim’s post. This is important. You must drill an osteotomy deeper than the implant you plan to place. Example: Astra multi-use drills are up to 1.45 mm longer than the implant and 0.9 mm longer for single patient drills. Therefore if you are placing an 11.0 mm implant you would need to drill at least to 12.0 mm to get the collar of the implant to seat at bone level. The larger the implant, the wider the final drill and therefore the longer the cutting tip. It is extremely important to know thoroughly the system you are working with. You are concerned with 2.0 mm of ‘overdrill’. You are therefore really concerned with only 1.0 mm of ‘overdrill’. This is of no concern as previously mentioned. Better to overdrill (assuming no anatomical risks) than have an implant not seat correctly at the neck.

  18. Dr Bill Woods said:

    “Pardon me, but CBCT has absolutely nothing to do with Correct implant osteotomies which have been around for damn near a century now. That has to do with deliberate hand skills.”

    How true.

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