Spinner Implant Case: What do you Recommend?

If the implant was spinning at uncovery (which according to you has been about 4-5 months since placement), I consider it a failed implant. The implant is spinning b/c it has not osseo-integrated which is defined as 'direct' bone to implant contact. If it's not in direct contact with bone, the implant surface is encapsulated with fibrous tissue, resulting in your spinner. I would remove the implant, make the osteotomy slightly wider and place a slightly wider implant. Good luck.

Dr. A This implant has failed. You must remove this implant, currette out all granulation and soft tissue. Irrigate the area with chlorohexidine or Saline. Graft the site, and return in back in 4-5 months for implant placement. When you come back to place a new implant, be sure to NOT use a cylinder with a few speed bumps on it:)

You said you torqued the implant to 35Ncm, but that the implant spun when you took off the healing cap. If the implant was loose, it's unlikely you could apply more than 10Ncm of torque. One option, if the the osteotomy is intact, is to place a 4.8 implant, but only if the ridge is wide enough and you have enough interproximal distance. Straumann bone level implants should integrate much better with less crestal bone loss. Otherwise, the advice above (graft and replace) is standard protocol.

Dr A There was a bit confusing about implant spinning when you were removed the healing cap, but you can torque the abutment ( I assumed) to 35N. this is little bit strage. if tou can torque the abutment to 35N, it should be ok to continue wtih the restoration.

When the implant spins, it clearly indicates that the implant has not osseointegrated. It may need what has been suggested before. For irrigating I would prefer Povidone iodine than Chlorhexidine, because of many reasons. Enlarging the osteotomy site and inserting a larger implant would be the best that can be done in such a situation

Spinning of implants is an indication that osteintegration has failed. I would take the implant, curretage,irrigate with saline and graft the site and go back in 4-5 months to ensure high sucess. 2nd option If you are willing to take a chance curretage, irrigate, widened the osteotomy ( if you have enough buccolingual width and place a wider implant . I did one case like this in similar area was sucessful. Good luck

It appears to me that you have the ability to place a longer implant. I would remove the current implant debride the site ( I do not like iodine since there a a significant number of people with allergies)and place a wider and longer implant. I would think that even if you can't place a wider implant, a longer stable implant in a well debrided socket would work. I would only graft and start from scratch as a last resort.Btw is that a bone level implant?

The angulation of some of your PAX is quite variable. You did say that you have already done an osteotome sinus lift?? (Hard to tell from some of the post op films). If this is the case, I wonder how stable a longer fixture is going to be since the additional length is going to be in the grafted sinus.

How long a healing period before you removed the cover screw? It looked like a very nice case.

First, to answer a question in a previously posted response above, this isn't a Straumann bone level implant. Almost certain it is a regular collared implant placed at bone level. I would bet that it is a "regular neck" with a 2.8mm polished collar above the 10mm textured surface. - To the original question, need to make sure that I have interpreted it correctly. From what you have said above, there are no signs of infection. Additionally, you have not torqued down the the healing cap to 35Ncm (either initially or subsequently.) If you have torqued down the healing cap, you "may" never be able to remove it without unscrewing (deintegrating) the implant in the softer maxillary bone. There are no anti-rotational slots or groves on the external textured surface of the Straumann regular implants. You can torque down the insertion device to help verify initial stability, but not the closure screws or healing caps - just hand tighten them (no wrench) with the spline driver. - Pretend the above is not the case and that you have tried to loosen the healing cap as a partial measure to check integration. In doing this, the entire implant turned instead of just the healing cap. I have had two such maxillary cases with, as far as I could determine, no reason for the non-integration. I was able to remove both with just the spline or hex driver and no wrench. - The safe method for fixing this problem is to follow the advise above. In my series of "two" whole cases, I was fortunate to have had successful outcomes not doing the above. I removed the implants at discovery and thoroughly debrided the sockets. I found no evidence of infection, but only fragments of a "very" thin, fragile and transparent membrane partially lining the socket which I removed entirely. The groves matching the threads on the implant were readily apparent in the bony socket. The bone bridge to the sinus was also intact. I did not have the option of going to a wider implant (biologic width) but probably would have if possible. In short, I then replaced the implant with a new one of the same dimensions which integrated successfully. The initial stability was >60Ncm. - I'm not advocating that you try this even if the situation you have is exactly as mine. Just telling you what I did and the outcome. Personally, my only regret (given the outcome) was in not sending the tissue found for histologic evaluation. That would have given me a "chance" to determine, rather than just guess at it's origin. - Good Luck! - Dr. No

IT HAS FAILED! if had to guess the summers lift failed you and this is why we all suggest a minimum of 13 mm in the maxilla. The implant position doesn't look unacceptable. So one option is to go with a wider body, but you still will most likely not Have enough bone at the apical. learn to do traditional sinus lift, it is absolutey worth the extra 15 minutes. The only thing that bothers me about this question, is you don't know how to fix it. Who am I to say anything. I don't have time to go to implant ce courses, so here I am. Bv

I agree that the implant has non-integrated. Your only option at this time is to remove the implant, return it to Straumann for credit and wait 4-6 months before going back into the site. It's too bad --it looked real nice. Alan

I've had this problem several times with tapered southern implants (trinex). Some of these could be rescued. If U can remove the closure screw, try to torque down the implant gently with a spare fixture mount or an insertion device (southern implants, internal octagon set, this is a straumann replica). Put on a healing abutment that extends the gingiva by 2-3 mm. After three months, check again with fixture mount or insertion device or even better with Osstell. I've had five implants integrated this delayed way (ISQ>70!). No additional surgery, happy patiënt and doctor. I found this trick somewhere on this forum, can't remember who I have to thank for this, but it worked for me. Good luck!

If you decide to remove the implant and fully curette the site please DO NOT graft it. If you graft it you will not be able to go back in to place a new implant, of what ever size you choose, for six months. If you leave it alone and treat it as an extraction socket it will have filled naturally with good quality bone in three months and we all know we prefer to place implants in natural bone rather than grafted bone (if we have a choice)

with almost 4 months(?) gone & implant spinning, it is indicative of failed implant(fibrosseous integration).The only option left is implant removal & preparing larger osteotomy site as recommended by most of the colleagues.Personally i dont think the sinus lift is responsible here. try bone compaction in the impant site & inserting implant with handwrench instead of handpiece...Experts plz comment..Thank you for sharing the case. Good luck

I agree , I don't think the lack of "sinus lift" is to blame. The epithelium that rest between the Implant and host bone, is the problem. So, if you can assure yourself that by enlarging the sight with a larger diameter osteotomy, that you are getting rid of the epithelium and not overheating the bone, your patient might have a chance. Your implant I'm my opinion is too short. Bv

iam with removing the implant currete , irrrigate and graft the site , back 4-6 month and another implant placed becuase the rotating implant means fibrointegration and so failed implant simply

Osurg. , are you really concerned about iodine allergies? You are aware that most of those are iodine based dies used during iv radiologic procedures. I prep all my trauma patients with at least a fifty/fifty iodine/ saline mixture. If you were to have an event, you probably have an iv started. You are certainly set up to handle an allergic reaction,in the off chance it may occur. Is there some new stuff out there, that I'm not aware of , regarding topical iodine allergies ? Bv