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Problem implant case with mobile implant: comments?

Last Updated: Oct 22, 2019

I have 47 year old male patient in excellent health, non-smoker who presented initially in November 2012 with a failed post crown on #10 [maxillary left lateral incisor; 22;UL2] due to a vertical fracture through the root. This tooth had root canal treatment and an apicoectomy. A radiolcuent lesion was present.

I extracted #10 in December 2012 and found that there was no buccal wall. I placed a resin bonded fixed partial denture (Maryland bridge).

4 weeks later I laid a full thickness flap around #10, curetted out the granulation tissue did socket preservation with OSTEON bone graft and membrane with primary closure. I prescribed a systemic antibiotic.

6 weeks later the patient returned with purulent discharge from the sinus. I prescribed an antibiotic.

I later installed a 10mm implant with cover screw 6 months after the bone graft and buried it. I positioned the implant palatally. I planned to do a screw retained crown.

At the 2nd stage uncovery 9 weeks after implant installation the implant was mobile. I could feel it spinning. I decided to leave it for another 6 weeks before making an impression.

At 6 weeks later I mad a final impression and the implant seemed to be osseointegrated. I attempted final try in of the crown 2 weeks later and everything was fine. I removed the crown and replaced the healing abutment so I could restore the distal surface of #9 [maxillary left central incisor;21;UL1]. At the next visit after restoring #9 the implant in #10 site was mobile again? Did I not wait long enough for complete osseointegration? What should I do now?

preop preop
preop preop
2 months after bone grafting
implant placement
final crown try in

7 Comments on Problem implant case with mobile implant: comments?

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Peter Fairbairn

10/22/2013

Sadly no room for praying for a miracle in Implant dentistry. When it first spun at 9 weeks ( why so early in a grafted site ? ) you should have removed it. Qsteon has HA in it and the infected site was possibly not managed efficiently resulting in granulous tissue with some HA in it ....OK for an X-ray but not for integration sadly . May need to re-do the whole site being a bit more thorough and thinking about materials and healing. Regards Peter

CRS

10/22/2013

Three Hail Marys and an our father should suffice. Not sure but suspect that the original infection or the graft material are suspect not to mention the timing and sequencing. Need to remove implant and graft material and start over.

domis

10/23/2013

No amount of prayer will help other than physically getting rid of it, thorough curettage and wait for a few months before replacing.

satya kode

10/24/2013

sir, actually here after extraction , extraction socket should be allowed to heal on it self for 6 months, so naturally bone would have been formed at that place. here again problem with osteon is it a scaffolding material , it is inert , not having capapcity to induce bone formation. in xray clear cut demarkation between natural and artifical bone graft indicating connective tissue capusle formation around bone garft. implant is placed in this capsule. so naturally it will have mobility.

Dr. Alex Zavyalov

10/24/2013

Good educational post and satya kode comment

Szymon

10/27/2013

You wrote the patient had suffered with purulent discharge from the sinus. Look at the apex of canine. Is it not a broken root tip after complicated extraction of posterior tooth?

Richard Hughes, DDS, FAAI

10/28/2013

Infection aside, look at the meds the patient is taking and their over all health and habits. When you perform socket grafting or bone grafting in general - one has to decorticate to receptor site. You need blood to make bone, stable graft, sterile environment, you have to block out the in growth of epithelial tissue, to name a few but not all the ingredients. Sometime it's easier to expand the bone and place the implant. Don't need. Graft or membrane.

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