[Diagnostic / Planning]  implant failure


This 5.0 x 10mm Replant (by Implant Direct) failed after 2 months post-treatment (preload) in site #3.7 for a 60 year-old female.

What are some possible reasons?

by Majid Sherkat at Mon, Jun 20, 2011 7:53 PM

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Mark Kwon Replied at Fri, Jul 8, 2011 1:25 AM

IMPLANT DIRECT might be the problem. heh~ I dont have much experience with ID implants; however I do notice more coronal bone loss with ID implants due to their coronal micro thread design. Just my two cents. As far as contributory factors? too many things could cause failure. Remember! Osseointegration success is unfortunately not 100% (... but pretty close i would say) thanks for the post. - mark

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Bernard Jin Replied at Thu, Jun 23, 2011 10:53 PM

Ok. Let's rule out insuff. irrigation or overheating. If overtorque is very high - possible that failure could be result of pressure necrosis. I have noticed this esp. with Actives when insertion torque is up to 70+ Ncm. I suppose its possible that the use of Fosamax may be contributory - but I have not personally noticed my patients with a history oral bisphosphonate respond in quite this manner. Did you cover the patient with antibiotics pre-/peri-/post- surgery? if so, what kind and how much? how about topical antiseptics? Also, did the cover screw get exposed despite achieving primary closure and healing? Or did it not achieve primary closure? On the radiograph - it shows a healing abutment. When did you decide to change the cover screw to a healing abutment - and did you try any strategies to manage this? how about the soft tissuebiotype around the implant site (pre-/peri-/post- surgery?)

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Majid Sherkat Replied at Thu, Jun 23, 2011 6:06 PM

Torque was above 35 but cannot quantify as the wrench goes to 35 only. However, it was much higher than usual. Irrigation was both internal and external; so bone over-heating is possible but not probable. Not a smoker but history of oral Fosamax use 1x/wk btwn 2003-2009. Tooth #3.7 extracted due to endo failure. When implant failed there was cover screw exposed with purulence and slight pain upon palpation.

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Bernard Jin Replied at Thu, Jun 23, 2011 3:16 PM

One thing that comes to mind is possible overheating of the bone when performing the osteotomy. When I look at the implant with the healing abutment, it looks to me the adjacent bone seems to be more radiolucent - with a conical pattern to it. This could be a possible explanation - possibly the irrigation was turned down more than desired, or that the osteotomy could have led to overheating of the drill bit. Just my thoughts.

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Bernard Jin Replied at Wed, Jun 22, 2011 6:46 PM

Ok. No graft was performed. You torqued it above 35 Ncm. By how much? Do you know? Less than 55 Ncm? Or above? Is patient a smoker? Any history of bisphosphonate therapy? Did you achieve primary closure at time of implant placement? You mentioned the case 'failed after 2 months pre-load'. What criteria did you use? Did you notice exposure of the cover screw? threads? purulence? pain? what is the patient's history with the site before you placed the implant?

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Majid Sherkat Replied at Tue, Jun 21, 2011 10:15 PM

The radiolucency at the apex of implant is due to osteotomy; originally I was going with 13mm length. No graft was placed. Torqued to above 35Ncm. Cover screw placed(no loading). At 2 months, changed to healing abutment(no loading)

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Bernard Jin Replied at Tue, Jun 21, 2011 4:54 PM

Hi, That's quite a question. Especially so many factors can contribute to implant failure. When i look at the radiograph - I notice a radiolucent zone at the apex of the implant. This may be infection? or possibly over performing the osteotomy? When I look at the radiograph with the healing abutment, it appears to me that a graft may have been performed (possibly simultaneously with the implant). If so, what kind? hard? soft? both? If grafting had been done, lots of factors come up - such as technique? maintenance of sterile field? adequate closure of surgical wound? Was there loading? If so, overloading may lead to failure. What kind of torque was achieved at time of placement? Lots of 'what could-ve been's. Bottom line - so many factors may have contributed. Maybe you could provide some input on the environment when it was placed.