Noble Tapered Groovy Issues

Don, a general practitioner, asks:

I started placing dental implants this past year using Noble Tapered Groovy and have run into issues placing them in my last two cases.

Case #1: #11 extracted and placement of Alvelogrove’s bone graft material and waiting the time recommended; approx 4mo. At placement the graft did not take and was removed. I called Alveologrove, makers of the bone graft and they told me to use their “Flow” material after placing a longer and if possible a larger one and the implant must not be like “sticking it oatmeal”, duh????

A call to Noble advised me to do the same and have similar results. I placed a longer one after syringing the “flow graft” into the socket, but was only able to get about 20 Newton’s of torque.

Case #2: Last week, a similar situation happened to a very similar case (extraction with graft, wait over four months then place #8 and 9) but this time the bone graft that I placed seemed to have taken better, however, I was only able to get “finger tightness” on the implant.

A call to a local periodontist I have used for over a decade advised me to remove the dental implant and graft again if I could not go longer/larger diameter and get the 35 newton’s torque. Due to anatomy, a larger diameter dental implant was not viable, but I did try a longer one without luck.

However, this one was not like being stuck in “oatmeal” as Alvelogrove and NobleBiocare said to avoid, obviously. It was not floating in the socket. It did have threads and could not be just pulled out However, I did what the periodontist I use recommended; I removed the dental implant and regrafted.

Any thoughts? The problem I have is a difference of what is considered “initial stability”. Will you always be able to get 35-40 newton’s of torque and what is considered adequate initial stability?