Implant Body Rotating in Osteotomy Site: Redo Surgery?

Doc.you didn't explan by the time of placing an implant it was placing an immediate implant on extraction site or not.Howevr, if it was an immediate implant on extraction site and your surgeon did minimom 4 mm osteotomy in the bottom of socket than placed an implant it's not his fail and you have to go on to next step.If your surgeon placed an implant on EDENTULOUS ridge you have to look for some patient's systemic problem or some TRAUMA after next vist by the patient.Finally, what do you need to do now? -Patient need to have the implant surgery redone with EXTRA(than previous)osteotomy and NEW implant in to the site. Remember, leaving an implant in the site for additional time is same as leaving fracture jaw without splint(NON-UNION condition) and eventually implant would be lost. Dr. Vaziri from Iran Tehran.

Only press fits should rotate, if challenged. If a screw in rotates-take it out and place a wider implant or graft and revisit.

The implant is a foreign body and needs to be removed. At best you would get a fibrous union, and this would rotate when you torqued in your final abutment. Here is why you DON'T want this to happen: 1.It hurts like heck 2. It makes you look like a fool 3. You now have paid for a final abutment that is useless. Refer this case back to your surgeon and ask him to re-do. If he is well trained and experienced, this should be a no brainer. He should be torque testing (or some other test) these implants before you restore them. Leaving this implant in at this point is only delaying the patient's treatment.

Implant must be removed,socket walls debrided, larger implant placed to replace the first one, and the patient put on Clindamycin, 300 mg t.i.d or q.i.d for 1 week starting 2 days before surgery to make sure that no anaerobes are present during first phase of healing. I would not do this as an immediate, but would use a traditional healing screw and cover over the implant for the traditional 5 months before uncovering. Note: If patient is wearing a partial denture during healing period, it must be relieved so as to not put any pressure on the implant through the soft tissue. Hope this helps.

Dear colleagues, please, I agree with all above mentioned statements, but: if the implant is long enough (e.g 11.5-12 mm) and is referred as "spinner"- then on the X-ray there is no significant zone of periimplant resorbtion, just probably the crestal 1-2 mm. In this case I`d speak with the surgeon send the patient back to him and ask him to "tighten" the implant until it arrives at 20-30N. If it does- put him on the transmucosal abutment and in 80 % of my cases (that is in 4 out of 5 of my cases), after a healing period of 3-4 months, X-ray showed reduction of the demineralized zone. Then I made a provisional (gradual loading concept) for another 1-2 months, then another X-ray, if all is OK- put the final crown. If you are in the "BAD" 20 % when after re-torque attempt, you fail.. Do as the colleagues above me. That`s what I`d do too. But remove the implant, debride everything, suture, wait for about 6 months, then start all over again. Usually the second time implantation is successfull. Best of luck: Dr Dimitrov

Dr.K The situation seems more related to the systemic condition of the patient. Either smoking or increased blood glucose levels could have contributed to the lack of osseointegration. Probably get a medical check done or assess the smoking status of the patient and proceed. Leaving the implant for another 2 months without assessing the above two criteria may not be of any help. P.S:(Seniors and Vetran clinicians please correct me if i`m wrong.)

If there is question about the implant at this early stage it should be redone. Why risk future problems. If it is not 100% from the start replace. There is no logic in restoring a questionable implant. It will only cause you and your patient needless trouble. I am sure you surgeon will feel the same way. Not all implants intergrate.Sometimes there are physiological, medical reasons, and some times it is just poop happens.

One of two things happened, 1. fixture failed to integrate and will require placement of a wider fixture or grafting and new implant depending on the site. This may show as a thin radiolucent line around the fixture. or 2. a green stick fracture occured within the bone around the implant due to the soft bone in the premaxilla and the integration between bone and fixture was not affected. If this occured then allowing time will allow healing and you can proceed. In softer bone its always wise to hold the parts on the fixture (abutment or impression head) to create counter force when tightening the screw

I am a general dentist. Last week a patient came into my office c/o a loose implant crown #8 that was placed by a GP. Her husband had the same issue with tooth #9. I have no idea if he took an extensive implant training course. I suspect he did not. I immediately referred this patient to a Periodontist who will take care of this in the correct manner for this patient. I ask the following: Is a GP doing a patient any good when he takes a weekend warrior class on Implants and has a much higher that normal failure rate? Or was he placing this for financial gain with disregard to the patient's health habits and medical condition? There are way too many lawyers waiting to hang us!

RichieG: Sometimes you can get loose crown over implant. The screw can get loose. There is a many reasons for that it can be not torqued enough, bite issue, etc. If the crown not completely out and still hanging and you can not unscrew it then 2 options: 1. you can replace this crown totally 2. Make a small hole in occlusion to to gain access to the screw and torque that down, then close the hole with composite. I usually do option 2. But don't think that periodontist will do better job than general dentist will do. its all depends on your experience on how to handle complications. Of course if you not sure how to handle then you did the right thing by referring this patient to someone who knows more.