Implant Crown Sunk into Tissue and is Mobile: Any Insight?

Without an xray this is just a hunch-- Your inital stability could have been engagement of the sinus floor and the cortical bone of the crest. All the other bone could have been D4 and there was then resorbtion of the bone that was stabilizing the implant initially. EWhen the the implant was restored and occlusal load added, the softer bone just could not handle the bone. As I said, this is just supposition from my end. The other possibility is that the odds just caught up to you... with implant success rate at 98% in perfect bone you would have about 4 failures minimum according to the odds :) Don't let it devistate you. It is part of the game we play.

Possibly another idea based w/o an Xray: Perhaps the abutment was screw retained and loosened. Maybe the sinking and mobility is just a loose abutment and some gingival hypertrophy giving the appearance? Take off the crown and abutment and see if there is implant mobility if there isn't then just tighten the abutment screw and recement the crown with temp bond. If you have implant mobility then maybe Dr C.S. is right. If you do it over maybe consider progressive loading??

I think the bone was not ready for the loaded implant. Even the best of grafted bone will be less than 50% at one year. A PeriotestM will give you readings of how well osseointegrated and stabil your implants are. Some Drs love the device some find it not so usefull. Savin sells it, and it saved me from early loading more than once and paid for itself. Good luck.

If the crown has sunk 3 mm into the gingival tissue, and is a little mobile.....you are sure of one thing....you have a 100% failure on your hands.Do not let this destroy your ego... you are now a fully fledged member of the Dental Implant Reality Club..... welcome, it happens to the best of us. You must be cautioned at this point,( you did not specify if the crown was directly screwed to the implant or was it cemented to the abutment), it would probably be best to try and tie a piece of floss to the implant body before trying to extract for safety purposes. The mobility has cause the initial osteotomy diameter to expand, and if the implant and crown should separate, the implant could easily end up in the sinus. Should the implant slip into the sinus, as it does happen on rare occasion, it is harmless, and if need be;it could be removed by an ENT specialist who puts a camera and retrieval device into the sinus. Should this unfortunate incident happen to you, you are guaranteed a membership in the International Sinus Sailer's Society..... good luck and be careful. Dr. Gerald Rudick Montreal, Canada

Not everything works like you plan it, regardless of how well you performed the procedure. Obviously, the grafted bone was not integrated to the implant. Even an x-ray can not tell you if the bone is strong enough to load. Sometimes, it looks like we have bone, but it is just graft material that has not resorbed or integrated. There may not be any angiogenesis in the graft material. This is most likely to happen, if it is a sinus graft and the patient contaminated the graft material before any angiogenesis or new bone growth starts. The most common contamination is smoking, but low grade infection can also cause this. The cortical bone might have given you the impression that you had enough resistance to place the crown. You may have even been able to torque the retention screw to 30 Ncm. After restoration placement, the dead graft material will then resorb, giving the next x-ray a totally different look. It’s all part of the game. We do the best we can and usually, everything works out. The successes make the failures worth while, as long as the patient knows the risk when starting.

Manosteel is probably correct in mentioning progressive loading. A typical routine is (for me) abutment on at 20Ncm for 3 months and then retorquing to 32Ncm. Two other things, I leave the restorative phase until 5 months has passed so that by the time the crown and abutment is ready, 6 months has passed before the first insert (at 20Ncm) is made. The other thing was her perio state. You were probably taking a gamble if she had achieved anything other than excellent dental status. That is, if she can't floss and look after her teeth, what chance has her implant? regards John

bEN: DO YOU HAVE ANY RADIOGRAPHS OR PHOTOS OF THIS PROBLEM?

Dr. Pete What graft material did you use? Greg Steiner

After tying floss around the implant body (if you can), carefully engage the implant with the same tool you used to place it and reverse it out AT AN ANGLE (tip your handpiece to the buccal). By reversing it an an angle, some of the implant will come in contact with palatal bone and allow it to spin out. Don't ask how I know this works :-).