Implant failure possibility?

I am a 60 year old male patient. I had a bone graft on the upper right side of the mouth, which resulted in uneven bone formation. Within 6 months of the bone graft, I had one implant placed in the middle where bone height was maximum. 4 months after the first implant was placed, I had two smaller implants placed, as seen in the image, on the sides of the first implant. Additional bone graft material was inserted to the right side where there is a bigger void, and a sinus lift was performed at the site of the implant to the left. All implants are Nobel Active implants.

What do you think of the spacing between the implants? Also, it seems like the new implants are very close to the voids on both sides. Does this increase the possibility of implant failure? What can be done to ensure success as this case proceeds? Any help would be highly appreciated.

10 thoughts on “Implant failure possibility?

  1. Gregori Kurtzman, DDS, MAGD, FACD, FPFA, DICOI, DADIA says:

    I think the spacing between the implants is appropriate. The only potential issues is the back implant has less bone over part of the top back edge. This may as the graft condenses cover this better but not having the tip of the implant covered doesnt necessarily lead to issues. I would wait till they are ready to restore then test all three with an electronic implant tester to see how well integrated they are. Worse case that area can receive additional sinus augmentation. I would splint the three implants crowns together to better distribute load on the implants when chewing.

  2. DrT says:

    Yes, delay having restorations for at least 4-6 months and be sure the stability of the fixtures is confirmed both clinically and with CT scan

  3. perio d says:

    I wouldn’t worry about spacing between implants(it looks fine) or the bone at the apex of the implants within the sinus. Your dentist has done a good job and you can let him follow-up on healing and if he/she is worried about anything they can discuss it with you. I also would suggest the restorations be splinted.

  4. DrG says:

    Looks fine. Make sure you thank your surgeon for a job well done! Looks like he/she had to work hard to repair your atrophied maxilla.

  5. Dorian Hatchuel says:

    Hi Patient,
    The spacing is okay if the restoration will allow for good cleaning.

    The real question is why were the teeth lost? It appears to me from the radiograph that your front teeth are worn down. This results in excessive forces on the molar (back) teeth in movements of your jaws during parafunction.

    Ask your restorative dentist to restore your anterior guidance and cuspid guidance so that there is immediate disclussion of your back teeth in all movements. This will hopefully protect your implants.

    Good luck.

    • tony widmonte says:

      Dorien is 100% correct – we were all so focused on the implants that its easy to
      miss the bigger picture – you should follow up and restore the front teeth .

  6. perio d says:

    Or use an occlusal splint faithfully following restoration of the implants. I’m not a big fan of 10 or 12 anterior crowns just to address a wear issue. The cause of the wear will continue and you would still have to use a splint after the crowns are inplace or there could be even bigger problems over time.

    • DrA says:

      I was under impression that in order to properly restore occlusal wear that is shown on this pano, one must open the bite gradually from posterior region up to one mm in the molar area and then crowns can be made with anterior and cuspid guidance to avoid root canal treatments in anterior region.

  7. CRS says:

    Don’t like second guessing a practitioner with limited information from a patient, the treatment order is unusual and would feel more comfortable speaking to the placing doctor. Not exactly sure what this patient is asking for.

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