Immediate implant in molar region with NovaBone: recommendations?

3 months back we did this immediate implant placement with NovaBone putty [alloplast, calcium phospho silicate] after extraction and curettage of the socket.  We achieved primary stability of 35Ncm.  I am enclosing the x-rays.  Kindly suggest how much more time to wait for the implant to osseointegrate?  Or is this implant is failing?  What tests do you recommend I use to assess health and osseointegration?  What do you recommend I do?

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20 thoughts on “Immediate implant in molar region with NovaBone: recommendations?

  1. Remove it or you can wait a couple more months for it to fall out. I would suggest referring this to someone with more experience. You are burning bone in the meantime, fix the molar.

  2. It looks like you may not have placed it deep enough to begin with. Remember that you are going to get 1-2 mm crestal resorption of the ridge as the socket heals.

    It appears to be failing. What are the probing #s like? If deep, extract, graft, wait 2-3 months, then place new implant.

  3. If a miracle were to happen and this heals to the same pre op bone level, you would still not have a “bone level” implant. Explant now, graft and wait 4-6 months to get good healing. Then get a CBCT and replan case.

  4. Yes need to place deeper ( maybe shorter Implant due IAN ) then graft with an osteo-inductive CaP so it turns over to Bone .
    We can just push the Implant in with no PS and it integrates as long as the graft fully turns over to host bone .
    Peter

  5. which is your before and after radiographs? if the right pic is your 3 months recall; your implant is definitely failing, but if it is other way round and left pic is taken after 3 months then there is a different story. I myself prefer delayed placement in the molar region.
    Moreover, it is always advised to take care of any source of infection in the area prior to placing an implant.The adjacent molar does not look very healthy. Large calculus is present and the possibility of furcation involvement too.
    best of luck

  6. 1) Was there initial primary closure or a membrane placed?

    2) Is that all calculus on the mesial aspect of the distal tooth? It doesn’t then shock me that the graft would have gotten infected and fail considering the adjacent tooth’s periodontal problems. If an implant fails for no no obvious reason it makes good sense to check out the adjacent teeth – especially for endodontic periapical lesions.

    3) Even if the implant were to take there will be 2-3 mm circumferentially not in bone.

    4) I would suggest the implant hasn’t integrated yet, so, as others have mentioned use this opportunity to back it out of there. Send it back to Nobel, Hiossen(?). Clean the perio issue of the distal tooth, graft the removed implant osteotomy site and replace the implant in 4 months.

    My opinion: the implant will (maybe) osseointegrate. Even if it does, it will fail in a year or two. Then, the patient will be out an implant and implant crown and you’ll be forced to answer the question: “Why doctor did you restore it in the first place?” There will also be more bone loss that might make replacement of the implant all but impossible.

  7. Here are my observations and thoughts:
    1. This implant is a failure. It needs to be removed, decried socket, bone graft placed and return 4-6 months later.

    2. Bone grafting is not a miracle, and you can’t defy biology. The adjacent bone height will predictably determine how much bone you can gain when bone grafting the adjacent site. Looking at the vertical bone height at the distal neighbouring molar, you are superficial and this was never going to work.

    3. The implant you chose appears to be very long. What was the dimension of this implant? It appears to be 5×11.5 or 5 x 13.5. This was your error. There was no way you could have submerged this implant. Had you chose a 5×10, you could have placed it at the correct vertical position the adjacent bone level with more predictable results.

    4. Although you ask what tools you could have used to determine implant failure/success – this radiograph alone compared to the baseline radiograph should tell you this needs to be removed.

  8. Yes this is a failure. In a molar immediate for success you need a graft material that has been proven to integrate to the implant surface during healing. Novabone is perioglass in a glue and it is not up to the task in this application. Our grafts have proven to produce integration to implant surfaces when floated in graft material with no bone contact which is nearly what you have here. Socket Graft Plus is what I would have advised in this situation and cover with a teflon membrane. Greg Steiner Steiner Biotechnology

  9. Your new word for the day comes from a Yiddish expression….”SCHMUTZ”
    You have placed an implant into a very unheathy environment ….leading to periimplantitis.

    Recognize that the oral cavity has to be clean and healthy in order to maintain implants.

  10. You have a periodontal problem. Remove implant, clean out socket regraft, bury it further.
    Use versah condensing burs to get condensing instead of cutting; this will also allow for fresh osteoblast in the area. You must clean(debride) the socket thoroughly!!!!!!!! and irrigate. After you “bury” the into fresh bleeding bone, then graft over the coronal portion.
    By your initial P.A. you didn’t have good condensing efforts on the distal of the implant. The latter xray shows that you may have tarter approaching the area. I would suggest a cyto flex membrane over the grafted bone with figure eight suture if you can’t get primary closure. You need to GBR (a membrane)on it anyway. You can’t allow your patient to have poor oral hygiene and expect a good implant case!!!! If you have poor oral hygiene on adjacent teeth you should expect an infiltrate of microbes into your site and your site will fail everytime. I hope this helps.

    This looks like a 13 or 14 mm implant; use a ten milimeter. You are close to the mandiublar bundle. Using a ten and you will have more confidence/ success in this case. I am aware that you may be violating crown to root ratio, but I would feel better with a stable10 mm implant surrounded by bone and no parastesia as oppose to crown/ root ratio. Due this case without a block, use local only to insure no nerve involvement.
    PACK~~~Make sure you have bleeding bring osteoblast into this area. Make some holes in the buccal bone, and make sure socket is bleeding….brother!!!! Contrary, if you use versah burs socket won’t bleed, as their purpose is to condense bone; however, make several buccal holes to bring in osteo blast. Make sure you then PACK (condense your bone) Don’t be lazy. Make sure also that you are using a osteoinductive product.
    Don’t be lazy enforce oral hygiene!!!!!!! It seems like there could be a variety of reasons for the failure. Hopes this help. Dont open for 6 months. It won’t be ready at 4. U can remove cytoflex membrane in 8 weeks if you want or leave it in until you uncover, unless it gets super nasty, then patient can clean it with peridex and q tip

    side note….You should be wiping the patient down before surgery and using a sterile technique during surgery and this will keep microorganisms out of your surgery.

  11. Please do the explantation and then follow the routine way as to augment the socket waiting for 3 or 4 months re evaluate the region clinically and radiographically plan the prosthetic procedure[ I think you will have difficulty with the molar during prosthetic procedure[ treat the molar and then ı think you may go on with implantation if the bone has ossified sufficiently .
    Good Luck

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