Will this implant osseointegrate?

I did an extraction and immediate placement of an implant in a site that had considerable bone resorption due to a periapical pathosis.  I used a bone graft with NovaBone.  Primary stability was 5N.  Do you think this implant has any chance of osseointegration?

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26 thoughts on “Will this implant osseointegrate?

  1. i would have used Interactive by Implant Direct instead of Nobel Active and saved a considerable amount of money, plus it works in both dense and soft bone. But based on the picture, it’a toss up. I’ve seen them osseointegrate before, but depends on patient and if they disrupt it etc. Good luck

    1. So much is out of your hands. As long as the implant is rigid and infection free it should be ok. If there is movement discomfort on lateral pressure or infection you’re not likely to win.

  2. Apical primary stability is the key. No micromouvements= implant integration. I would have placed the implant deeper.

  3. As Dr. Dickinson mentioned, so much is out of your hands, but in this particular case if you had enough primary stability and the site was not infected during the time of placement it may integrate .I am not very much in a favor of the immediate implant in the molar region I personally prefer late placement in these cases. It is more predictable with fewer complications. I also prefer larger implants in that area.
    Thanks for sharing your case.
    best wishes

  4. First of all… What was the rush? Wait two months after the extraction and have excellent bone into which an implant can be placed in a predictable fashion. In addition, when you have a healed socket, positioning could be better. Right now the implant is placed slightly too far mesially.
    And finally, this is a molar, why not place an implant is wider in diameter such as a 4.8mm tissue level Straumann implant which also expands to a 6.5mm platform so that your crown is wider and allows for much less food impaction. At this point, there are many clones to this design and they all give a decent result.
    In short, waiting two months and placing a wider implant would give you a superior result.
    Best of luck,

  5. With only 5N initial insertion toque and the radiolucencies around it not sure much native bone was present when you grafted at time of implant placement. NovaBone is good material but this may have been better grafting the site with this and waiting a 2-3 months (till you could see opacity of the graft indicating it was converting) then placing the implant. I also would have used a wider implant to mimic the molar that was lost and get a better emergence profile. What diameter was the implant that was placed?

  6. Are you a religious person? If you are…start praying….
    ………if you are not……better find a suitable faith and start to pray!!!! Just kidding……

    What you did is not an impossibility……there are many factors to consider…..how did you cover the site? What kind of a membrane did you use ? Did the membrane stay long enough to allow soft tissue closure over the site?
    A suggestion for you…what I would have considered to do in the situation……

    (1) Do a PRF procedure so that you will have growth factors working for you , when you are ready to apply them (2) make sure the extraction site is cleansed very thoroughly and debrided before placing the implant (3) Shape and fit a piece of titanium mesh to the top of the implant, and fold it insuring that there are no rough edges sticking out, and cut a hole in it for the cover screw of the implant to fit through (4) remove the prefit titanium sheet, keep it sterile while it is out of the mouth by wrapping it in a piece of gauze soaked with Chlorhexidine (5) drill a series of tiny holes in the bone so that there will be an adequate blood supply (6) after you have pressed your Fibrin clots to make some membranes, put the exudate obtained from the pressing in a sterile syringe and soak the recipient boney site (7) apply your Novabone grafting particulate material (9) cover the graft site with one or two of the PRFmembranes you just pressed (8) screw on the titanium mesh with the implant cover screw (9) place the balance of the PRF membranes over the titanium mesh (10) cover the site with a PTFE membrane (11) place some sutures over the site to approximate the soft tissues (which will not close completely and should be tension free) (12) apply a periodontal dressing to protect the site (13) have the patient back a few times to change the periodontal dressing as well as rinsing with chlorhexidine during these pack changes.(14) keep a watchful eye on the PTFE membrane on a weekly basis, to make sure it is still clean and protecting the site and when you feel that there is some soft tissue developing, then it can be removed………at this point it does not matter if the titanium mesh shows some exposure.
    Developing bone has a terrific affinity to the titanium mesh, and a boney osteoid will develop with immature and unkeritanized gingival tissue on top of it.
    Wait four full months, have the patient keep his/her mouth very clean, salt water rinsing, peridex used each day…… and finally remove the titanium mesh and leave it alone for a couple of weeks…… the mesh acted as a growing chamber much the same way a plywood form will control the shape of the liquid concrete when a sidewalk is being poured, and the result should be very good. Even if a large part of the titanium mesh was exposed during the healing process, when the mesh is removed, new gingival tissue will form on top of the new bone (which will have the pattern of the mesh) …….. but cover with a protective packing as it is forming .

  7. For immediate placement in molar Area , I prefer Tri-Max 7 or 8 mm diameter Who gives excellent initial stability and good emergence profile

    1. Agreed! Keystone dental distributes the Max. Look up all the lectures and research by Dennis Tarnow on immediate molar placement.

      Next time think lessabout maximizing the $/hour and more about your stomach lining that is dissolving with worries currently.

  8. Doesn’t look good, but I’ve seen it all. Stability is the key. Key an eye on it and be prepared to scoop it out if need be.

  9. While “water under bridge” , I agree with the comment, what was the hurry. By waiting one would now have a positive ridge architecture allowing for ideal placement and a predictable result.
    BTW, we continue to still focus on particular implants, bone materials,etc when the environment and technique out weigh what we use.

  10. The issue here as I see it is:
    How good do you want the implant to be? This defect is large and will heal unpredictably regardless of the techniques used, materials added or skill of the surgeon. What will be the host response and initial cause of the defect is as important as the above.
    How predictable will the esthetics be ? You may end up with an integrated implant but with some crestal bone loss and poor emergence profile resulting in a poor gingival or general esthetic compromise.
    How long do you want this implant to last? Starting off with a less than optimal situation is an implant domed to survival instead of success.
    Even if this case works out, the next one may not, and is that worth the risk of failure and re-treatment.
    I offer these comments from a relatively experienced practice of implant dentistry and from a perspective of being at times an aggressive practitioner.

  11. I tend to steer clear of immediate Implants unless anterior esthetics demand it. If there socket is grafted then the healed site will have some resistance to placement torquing. The positioning of the implant in the posterior is also easier since I have a difficult time drilling the iñteràdicular bone dead center and having anything left to screw the implant into.

  12. Strangely I do this often and works well ,but slightly different protocol ( my published one ) with 3 week healing period . I just push the implant into the graft material with the cover screw driver …. so no Primary and no Bone to implant …. after 10 weeks mid 70’s on Osstell have a few video cases …… as well and many photo cases .
    The other thing is prefer to use osteo-inductive BTcP /CS materials which fully turn over to host bone ….
    But this case is not going to go well as material lost and exposure to the oral environment is not helping ….
    Peter

    1. Peter
      Osteoinduction requires an internal cellular reaction producing metabolic pathways that stimulate mesenchymal stem cells to divide into osteoblasts. bTCP granules are inert. The calcium in calcium sulfate is ubiquitous and the sulfate is a waste product so how is this material osteoinductive?

  13. Please wait for a long time exaple 4 or 6 months and give the implant a chance for osseointegration although distal gap has a new bone formation mesial gap may cause pocket formation so do not start prosthetic work until you are sure that osseointegration is compleated .Good luck

  14. If I were the patient I would have preferred you let the site heal and offer me the best you can. Did you inform the patient that the course of treatment you chose was the less ideal of 2 options available. In my opinion 2narrower implants would be the best possible service to the patient as that would eliminate the food traps that are almost guaranteed with the tooth Implant relationship you developed. Extra cost yes but shouldn’t the patient have the chance to decide how to spend their money?

    1. Thanks all ,for your valuable suggestions.
      I m a beginner in implant field and I have informed the patient about poor prognosis.actually he is a friend.although I have read about implant stability and contact osteogenesis but I still s believe that this implant will osteointegrate .
      Worst part is size I choose.
      Thanks once again

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