Failed Megagen Implant for Overdenture with Locators: Thoughts?

This situation is akin to doing an immediate placement into an extraction socket. You have the implant stable which is an absolute requirement. Rough surface implants are better at "bridging" than smooth surface/ machined surfaces but in a gap of this size we would always augment. It would be safer and simpler if the implant had been placed a little deeper and if the marginal gap had been grafted with a material which encourages osteoconduction and contains collagen. The collagen gels and tends to seal and protect the region from infection and infiltration in the first few critical days. We usually place a healing cap and bring the bone / collagen mixture up around the healing cap to form a type of "Safety Zone". We then bring the flaps up around the healing cap and close with sutures. Using this protocol there is no need for primary coverage and we get a thicker more bound down and mature zone of attached gingiva around the implant when it's time to remove the healing cap and take the final impression. At this time in your situation, you should hope that natural "bridging" will kick in for you. There would be no point in going back at this stage. I wish you the best!

How did you have a gap from a failed 3.5? It will probably be okay if there is no movement to the implant. Placing graft material in this gap is probably not necessary, any your flap design should aid in healing.

Thank you for your comments. On the hind sight I wish I had done some augmentation. Since the implant had enough stability I disnt think it was necessary. Hope it will bridge the gap.

What was the etiology for the first failure ? Always try and identify the etiology ( at least have a very good idea ) of a failure before you repeat the procedure otherwise you potentially risk making the same mistake twice. Patients can kinda understand and accept a failure. Second time around is another story and so everything needs to be close to perfect and by the book in every way.

Agree with Dok- it is always best to identify the cause of a failure, even though we often cannot. Two possibilities come to mind : one is surgical error i.e. overheating the bone during prep and the other common one is overloading that with a provisional. Although neither may be appropriate, something different happened in that area. It is so easy to be critical and for that I apologize, but one thought is that Misch recommended six months usually in this portion of the maxilla even though it would have made no difference here. And, I hate gaps.

The best graft for a small gap like this is the patients own blood and good primary closure. One could also consider the use of PRF but I do not think it would be needed in a situation like this.

After the replant site has been debrided and scraped, I prefer to place a small amount of the grafting material into the osteotomy, and then screw in the implant, this way you know that you have filled the spaces between the implant body and the bone.....PRF is very good to include in the graft mixture.

I don’t understand idea of grafting around an implant after it has been exposed to the oral fluids. It is impossible to decontaminate the implant surface. If you place a material to decontaminate the implant surface to remove and kill the bacteria, it will also indanger the fibroblast and osteoblast that are still with in the area.

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