Topic

[Surgery]  Failing Implant


Hi everyone,

Here's a complication that I saw yesterday, just want to confirm way to proceed.  51 yo female, healthy, no medications. Retained 65 became infected, extracted Dec 2015.  Patient waited for awhile for implant, placed implant Nov 2016.  Gave options of sinus lift or placing shorter implant (with pros/cons) .  On CT, there was just over 9mm to sinus.  Placed Hiossen 4.5x7mm implant with 40n/cm torque and 4x4 healing abutment.  Saw 3 weeks later, everything looked great.  Patient came early march for impression (4months after placement), again everything looks great.  MISTAKE- did not take PA with impression coping in (do this probably 85% of time, will be increasing to 100%!).  Place crown a few weeks later, screw retained from skycad.  She called a few days later, said its fine when I bite together but sore when I chew. Got her back in, took PA and as you can see there is bone loss all around fixture.  It is now slightly tender to palpation higher up in vestibule on buccal (she said it was not tender at all during 4month healing).  She leaves in a few weeks to India.  I took off crown and placed healing abutment back in. Implant fixture did not feel loose at all.  Is the only option to remove implant, curette, graft and let heal?  If so, tips for removing, haven't done this yet.  Thanks for any help/input!


by Trevor Lake at Wed, Apr 12, 2017 5:39 PM

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Likes : 1

Madeson Basie Replied at Tue, Apr 25, 2017 8:47 AM

Hi to Y'all :

Thanx for sharing this case ; and I appreciate the replies from Mark and Ho-Young . Certainly there is something here for us all to learn.

And Ho- Young , I certainly appreciate your attention to detail . I do not believe this is overkill.  It makes sense that we all do this  with all our dental treatments . Documentation and attention to detail helps to ensure success and provide medical legal protection. Thanks .



Likes : 2

Ho-Young Chung Replied at Thu, Apr 13, 2017 9:17 AM

Hey Trevor,

We have all had cases like these that we wish had gone better.  Thank you for posting it to the forum.  I agree with Dr. Kwon in that this implant is not salvageable at this point.  

This is what I normally do at the 4 month check.  Vertical BW and PA and often Pano and small field CBCT (if grafting of any kind has been done).  Some might say that is an overkill but I would rather take one too many radiographs then not take enough.  These are taken before I even come in the room to see the patient.  


I remove the HA or temp crown and check ISQ.  I realize that not every office has an Osstel or Penguin unit but I sleep heck of a lot better knowing that I have done an RFA.  This month alone I have had two implants referred from other offices where a reverse torque test was done and implant was either determined to have not integrated or failed later on.  It's an investment that doesn't pay directly but is a valuable tool regardless.  


Then we take PA w/ impression coping.  Take impression and send off to lab.  I check all my crowns when they come back from lab well before insertion date.  


At insertion appt, take vertical BW (if posterior and if it's going to be useful) and PA with crown on the fixture (but just hand torqued).  Confirm seating and confirm emergence profile, interproximal contacts, occlusal contacts, shade, etc.  Then torque down.  Check and adjust occlusal.  Torque again.  Wait 5 more minutes and torque final third time.  


If I have any concerns, I book patient for 2 or 4 week check after crown insertion.  This might be overkill but it's a system that my team follows for every case.


hope that helps.


Ho-Young



Likes : 1

Mark Kwon Replied at Wed, Apr 12, 2017 7:56 PM

Dear Trevor,

Good to hear from you.

Thanks for the upload.

If there's obvious bone loss, it be best to explant , Graft and replant in few month. 

Typical steps:

1.  Explant the implant using Fixture removal tool: There are two types available; a) Hiossen Easy Fixture Removal kit (EFR)- im not sure if it is available yet;  b) Universal fixture removal tool (Surgicalsmart.com  carries it): it comes with universal table chart for which core screw and reversing body to use; If it is RP connection , then it is the black core screw; I use this kit often.

2. upon removal , you can clean the socket thoroughly and either 1) replant using longer / and or wider fixture. Looking at the xray, i think you can go for 8.5mm length easily.   or 2) you can GBR (ie. socket graft the site) - I routinely use PRF+ cancellous bone mix for predictable healing

3.  revisit in 3-4 months for a new implant

4. SKYCAD might credit back the lab cost since the crown was only in there for a short time. (doesnt hurt to ask ^^)

- mark