Noble Replace CC Rotated After 4 Months of Healing

This case involved an otherwise healthy individual, non-smoker who underwent implant placement 4 months ago, presented for restorative appointment during which implant Nobel Replace CC 3.5x 11.5 in area #11 rotated about 1/8 of the turn and resulted in some discomfort for my patient. High resolution small view CT was ordered and area was evaluated. CT showed that implant was placed well within the borders of the maxillary wall. I am certain that since the implant has turned, it only means that I start with day 0. Thus, should more time be given for osteointegration, or should I replace the implant with longer implant? Please note that the reason 3.5 diameter implant was utilized was because mesial-distal space available between teeth 10x12.

Andy K comments:

Usually 6 months is a good time to restore the upper implant. The implant looks healthy. I will give another 3-4 months before placing final crown. We didn’t see the posterior segment, but make sure that the patient has good posterior support. I don’t think new longer implant is needed.

Andy K comments:

One more thing with restoring #11, due to the small size of implant, it’s better not to give full torque of 35/40 NCM. As long as patient has good posterior support, I usually stop at 25/30 NCM to prevent the implant to get rotated. Had couple cases like this, after waiting another 3/4 months, I was able to complete the final restoration without any problem.

Ash comments:

Check for vitamin D levels in the patient

Richard M. Benian comments:

I would remove it. Either graft and them replace with Nobel Active implant or Try to replace with Nobel Active right away. Make sure osteotomy site is clean. I would bet it is. Just did not integrate.