Pain on Apical Pressure after Short Implant: Recommendations?

Sorry probably failed , best to remove , any pain is and issue. Best of luck Peter

I agree with Peter, pain onpalpation or percussion at the time of uncovering means that the implant has failed to integrate. Since it is a wide implant, it is best to remove it, degranulate osteotomy site, graft and come back in about 6 months and place a longer implant that engages the floor of the sinus (because you were trying to avoid a sinus augmentation with your short implant). Good luck!

Did you take any radiographs? Any other clinical signs or symptoms? You don't need an expensive RFA machine. A simple mirror handle will produce a nice 'clink' sound when you percuss an osseointegrted implant. You should also be able to torque the implant to 35 Ncm without the fixture turning. Agreed with Carlos and Pete, not very good news.

I partially agree with Peter, I mean that the implant is in real trouble.You say that looks ok at the x ray, if that is so I would recomend a retorque before removing the implant. This means that under some anesthesia, remove the cover screw, place the driver and torque the implant clockwise, as much as needed( it wont be that much probably) untill you get half a turn, replace the cover screw and let it rest for a 8 weeks. then try and in most cases pain will dissapear, If not replace at the time. If ok let heal and you will get a fully integrated implant after maybe a total of 4 months. The idea behind this is to break any fibrous tissue and gennerate a clot, that in time will become bone as any initial clot would between implant and bone surface that has close contact and its quite protected. best of luck

A word of caution :- maxillary implants that have not fully osseointegrated must be approached with extreme caution. When attempting to test the implant by torquing clockwise, there is a risk that this implant may end up in the sinus, because the torquing wrench does not connect to the implant in any way except by engaging the hex when it is in position.( assuming that this is an internal hex implant we are speaking of).It is impossible to know what percentage of the implant body is bonded to the bone, and how much fibrous tissue separates the fixture from the bone, so that the implant may be attached "literally by a thread". It is unfortunate, that at this time, most implant manufacturers supply fixture mounts that are " breakaway types", so that no time will be lost removing the fixture mount from the implant body during the surgery. When removing the cover screw, by turning counterclockwise, it is best to use the old style fixture mounts that have the same screw to engage the implant as does the abutment fixture. Should the implant be loose, it cannot fall into the sinus because the diameter of the fixture mount hex handle is larger that the osteotomy and the implant is firmly gripped and under the complete control of the operator. Over the many years of using the implants manufactured by Medigma Technologies which are internally hexed, I made a habit of saving these throwaway excellently machined handles, and very happy I did so. Medigma Technologies has merged with Adin Dental Implants, and some of these old style fixture ,mounts may still be around. Gerald Rudick Montreal

I quite agree with you but I recomended this procedure because Dr M. was quite clear that he has 1mm to the cortical of the sinus. The breakaway transfers can be used again but one needs ton activate the grip. Yes its better if you have a screwed in one. cheers

Lots of recommendations, with little information. If the implant is integrated and certainly you checked that at second stage, then I wouldn't be so quick to call it a failure. There could be several things going on and without more information, we are just waisting time. Does this patient have a psych. history, is there an abbérant branch of v2 near by? Is his pain threshold unusually low. Where is the beef???? Bv

Can use Osstell to check but suspect there is a problem

Hello Just check with a torque wrench without anesthesia that how much torque implant bears with no pain. If it bears a torque of 20 N, wait for 3 months and then re-check. Best of Luck buddy