How to repair a failed implant site?

We placed two 3.25mm Engage Implants in the #12 and 13 sites on a 70+year old female. The procedure was uneventful. We had her return 4 days post-op and she had a flipper (temporary acrylic removable appliance) that was riding on #12 implant  and was relieved.  But 6 weeks later #12 implant was failing.  Both implants had been torqued to 40Ncm. My question is after removing this implant, how would you treat this case?

13 thoughts on “How to repair a failed implant site?

  1. Brian says:

    I am not half the surgeon some on here are, but that implant really looks like it dug into the root of 11. Could that have been the issue? Could you cantilever off 13 now?

    • Dr. Raymond L. Wright Jr. says:

      It is possible that tooth #11 has a peripical infection due to implant #12 in its periodontal ligament space that has led to its failure. I would remove implant #12, bone graft the site and monitor #11 for possible root canal treatment. I would replace implant #12 four months later.

  2. Daniel R Sweet says:

    You should have known from the guide pin that the angulation was wrong.
    Also,, too big of implants for area,,, review space requirements, you can measure on a model..and make a splint.

  3. rsdds says:

    don’t feel bad the distal angulation of the upper canines can be a pain in the a.. remove graft and retry. Did you measure m-d space you need min.. 13mm it looks kind of tight…

  4. Bruce A Smoler says:

    all too often, without a cone beam, angulation issues both positive (more room) or negative (less room) can be misleading. From a study model, the arch width can be assessed and if needed, mesial of #14 can be shaved to gain prosthetic space of 1-2 mm if needed as well as any distal bulge of a cuspid can be reduced. I agree that the prosthetic space between the implants are slightly close together.
    My advice, explant #12, graft, evaluate #11 for any untoward apical issues. Be sure of the space constraints for replacing #12 more parallel to #13. Out of curiosity, do you know the width of the space between #11 and #14?

    Good Luck

  5. Dennis Flanagan DDS MSc says:

    Check vitality of #11 may be necrotic. #14 may have a cracked root. If #12 was a failed endo there may be residual vegetative planktonic forms that colonized the implant. Debride the site and place a new smaller diameter implant if the facial wall is intact, if not graft and wait 3-4 months and revise.

  6. Michael says:

    Don’t place a removable denture on non buried implants. That would be step one. It may have been Bette to splint them then to place healing abutments and they let a rpd ride in them. Since it was not the goal to load them right away, I would have submerged them. At any rate. Let the area heal now and explore to reimplant in 8 weeks. You may have a problem with 13 too. Bury them and let them heal.

  7. Hank D. Michael, DMD says:

    As stated above, give yourself more clearance to adjacent teeth. You can use a Lindeman bur (side cutting) to change the angulation of your implant osteotomy when you see it is too close to the adjacent tooth with the parallel pins. You can also move an osteotomy buccal or lingual as necessary before you go to the final drill.

    I actually don’t think you nicked the canine but it’s too close for comfort. I do think the cause of the failure was from the removable appliance. I would rather immediately load the implants with non-functional temporaries than use a removable appliance. If you have to… relieve the heck out of it. Then the patient complains of a food trap. I use under prepared osteotomy condensed with osteotomes or Versah implant drills to prepare for immediate implants or implants in soft bone.

  8. Peter Louie says:

    Too many implants. should be 3 mm minimum between the implants and 1.5 mm minimum from adjacent tooth. If they are failing, it would best to remove them and regraft. The longer you wait the more bone will breakdown and it will make the situation much worse to deal with.

  9. rsdds says:

    I’ve made this mistake before but never have I left an implant like #12 in place because It looks really bad. If the pt. goes for a second opinion you are in deep trouble.. We all have bad days.

  10. Harry says:

    How to fix the case would be to do it right the first time. Angulation off, implants need to be 3mm from each other and at least 1.5 from adjacent teeth….I would regraft, let it heal, and replace the implant at a better angle – only if you have space. Just because someone has two teeth missing does not mean you get to place two implants. Measure….you need 1.5mm from each tooth, so 3 automatically and 3mm between implants, so 6mm total of empty space, not including the implants. you placed two 3.25mm so 6.5mm. Do you have 12.5mm of space? Then you can do two implants. My other hesitation is that the molar site is where lots of ‘heavy lifting’ occurs, so placing small diameter implants may not be a good idea. Good luck.

Leave a Comment:

Comment Guidelines: Be Yourself. Be Respectful. Add Value. For more details, read our comment guidelines. Though we require an email to comment, we will NEVER publish your email.
Required fields are marked *

This entry was posted in Clinical Cases, Surgical and tagged .

Videos to Watch:

Dental Implant for Lower Right Second Molar

This video shows implant placement on the lower right second molar.[...]

Watch Now!
Saving a Bridge with Periodontal Therapy

This video shows a case involving a 48-year-old male who was referred for periodontal treatment[...]

Watch Now!
Immediate Loading Full Arch

This video shows a case of Immediate loading of a full arch with simultaneous guided[...]

Watch Now!
Apically Repositioned Flap Technique Around Implants

The apically positioned flap is a commonly used surgical approach, that may help the long[...]

Watch Now!
Digitally Planned Bone Augmentation and Immediate Implantation

This video shows a case using the Ring technique to provide bone augmentation along with[...]

Watch Now!
AnyRidge Implants: Replacement of Upper Left Molars

This video shows the replacement of maxillary upper left molars with Megagen AnyRidge Implants.[...]

1 Comment

Watch Now!
Guided Implant Surgery & Immediate Temporisation

This video demonstrates the placement of a missing pre-molar using computer-guided surgery and immediate temporization.[...]

1 Comment

Watch Now!
Implantoplasty to Treat Peri-implantitis

This video shows the use of the Implantoplasty technique to treat peri-implantits. Granulation tissue and[...]

9 Comments

Watch Now!
Placement of Implant Using EZ Devices

This video demonstrates the placement of a dental implant in the upper jaw using the[...]

Watch Now!
BonePen: Improve Positioning of Implants

A short video demonstrating close up the use of the BonePen Kit, a set of[...]

Watch Now!
Vertical and Horizontal Bone Augmentation with Khoury Bone Plates

This video shows a way to utilize thin autogenous bone plates to create stunning bone.[...]

4 Comments

Watch Now!
Maxgraft bonering: immediate implant placement

This video shows a live surgery using the maxgraft bonering, which is a pre-fabricated[...]

1 Comment

Watch Now!