Yesterday I had a patient with failed second molar of right mandible that was extracted one year before.We decided to place a Nobel Replace tapered groovy 4.3 × 10 mm.
First I used the pilot drill 2mm and when I reached the final drill for 4.3 (yellow) I started to insert the implant with the motor at 25 ncm. I had checked the walls of the implant bed and the bottom with a depth indicator and xray. Also I had distance from mandibular canal 2 mm.
However, when I reached at the 2/3 of the height of the implant I felt the implant screwing-falling to the bottom of the bed…like falling when you are in a lift..!
No primary stability!! It was a very big surprise for me since I have experience in oral implantology. But it was my first time using the Nobel System. Usually I use Xive, 3i Biomet and MIS.
I decided not remove the implant and I tried to screw the cover screw and it was screwed with the implant (like the whole system implant-screw was spinning…)
I placed sutures and I pray now for a secondary stability while osseointegration process.
What is your opinion? Did you have any similar cases with the Nobel system?
By the way, I was thinking that the soft bone was the cause, and I had to stop drilling with the 3.5 drill, but the protocol says that the final drill had to be the yellow for a 4.3mm diameter implant in any case of bone, and in case of dense bone to use further tapping drills. Thoughts?