Failed Immediate Ankylos Implant: What Happened?
This case involved a young male patient, asymptomatic root in region 35. After clean atraumatic root extraction , and thorough cureting , with nice soft tissue and bleeding, I felt confident for an immediate implant placement.
I did not use any drill ,just the respective reamer and tap for 3.5 Ankylos. Sufficient stability, no bone graft. I placed Gelatamp atop and primary closure. No antibiotic were prescribed.
At one week recall , patient did not have any complaints, and wound was closed . And so time went on. Patient never experienced any discomfort, and I had high hopes that this case would turn just right . Patient did not show up until today, 5 months post op ,after I tried to contact him several times couple months ago.
I noticed significant volume shrinkage from facial aspect as if buccal plate was gone! Soft tissue was not smooth, looked wrinkled. It seems evident that my first immediate Ankylos failed.
Any thoughts as to why this immediate implant failed? And how to proceed further?
11 Comments on Failed Immediate Ankylos Implant: What Happened?
New comments are currently closed for this post.
CRS
5/31/2016
I betcha there was absent or thin buccal plate, or implant not deep enough in nascent apical bone, impossible to tell without preop film. I like to raise a small flap to see the bone. Could have gotten an infection at the critical 6-8 weeks integration stage. It's not a typodont, cadaver or pig mandible like they use in the implant courses!
Peter Fairbairn
5/31/2016
Immediate placement great in theory ........ but when I tried about 8 years ago just got a lot more failures ...... maybe I did not have the skill set ..... anyway stopped and prefer to see what the true story is hard tissue wise .
Site preparation is a vital part to success .....
Basics of biology must be adhered to
Also Ankylos have a very particular placement and you cannot force them in due to design .
Good Luck
Peter
Frank
5/31/2016
Lower bicuspids seldom have buccal bone. Very often they present buccal dehiscence.
Even if a cortical plate is present it will be bundle bone that will resob. So this area needs to be treated like upper anteriors. If immediate placement you need to graft on the buccal. Otherwise extract and graft socket.
Even delayed placement with grafted socket will often need GBR at placement time.
Sb oms
5/31/2016
Lower bicuspid immediate needs to be prepped into lingual bone-as stated above, buccal bone is always thin in this area and can easily resorb when implant is cranked up against it.
This is a tough spot for immediates. It's taken me a while to develop the skill to prep into lingual bone- but just like in anterior maxilla you want implant away from buccal plate.
Also requires sharp drills.
Upper bicuspids are way more forgiving for immediate placement.
Big Googootz
6/1/2016
Immediate placement:
Antibiotic coverage before, during, and after
CT Scan
Peridex pre-op rinse
Post exodentia eval of bone
Curettage socket like a possessed gopher
Place implant more lingually than root and more deep if possible
Bone and Guided tissue is usually required
suture securely
An offering to St. Apollonia couldn't hurt
vale-
6/1/2016
Thank you all for your valuable comments !
Implant removed. I noticed blood oosing slightly lingual when I pressed the soft tissue. Obviously was a communication tract.
To my surprise there was good buccal bone about 1mm thick and at fixture level ,but much of resorbed lingual and distal bone .
Lesson learnt .
CRS
6/1/2016
I think had you followed the advice of placing the implant more lingual which I would not advise there would be a definate chance of a lingual shelf or floor of the mouth injury with serious hemmorhage.
I like to raise a small buccal flap and I use the lingual plate as a guide for depth it is very easy to perf the lingual plate. Placing an immediate more to the lingual/palatal is the protocol for an upper implant. I rarely place immediates unless the socket is perfect and there are no anatomical hazards. Flapless procedures add an additional element of risk to a already "blind" procedure. Immediates are tricky I would rather graft and stage especially on a new patient, I don't know how they will heal and be compliant with home care and follow up. Good post.
Dr. JL
6/2/2016
Possessed gopher! I can only dream that I can attain this stature.
rsdds
6/2/2016
from my experience this looks like lack of retention and stability on top of everything mentioned implant did not fill socket and its ok not to do so if you can increase length by 2-3 mm and graft space b/w implant and bone. Without 3D is hard to do so without potentially hurting pt.
greg steiner
6/13/2016
The biggest reason for implant failure to integrate in the lack of systemic antibiotics. However in this case you report no signs of infection so that is not the cause. We know from research that any area that is not in contact with bone will not produce integration. In your case it appears very little of the implant was in contact with bone. With only a small portion of the implant in contact with bone integration will not occur unless you are using a bone graft proven to produce integration in those circumstances. Greg Steiner Steiner Biotechnology
Camthejam
6/22/2016
I have been placing Ankylos for many years now. I have had more failures with Immediate placement in the mandible. Now I extract, graft and wait 4 months, then place....I have had much better success. Additionally, Ankylos likes cancellous bone better than Cortical. And I also have found that on immediate placement, Ankylos likes at least 4-5mm of native bone. At the University of Frankfurt, they have been a longitudinal study for over 25 years now. They recommend narrower implants in the mandible. Dennis Tarnow has shown that a more tapered implant has better long term benefits in immediate placement. It looks like from your update post that you figured out the cause of failure. Dentistry is a constant learning experience! Keep it up!!!!
