[Surgery]  "Spinner". Replace or wait .


i just placed an 4.0x11.5 on Saturday in the 15 position. Soft bone. Type 3/type 4. Not sure. Osteotomy underprepared to 3.5 but I still managed to get a spinner. I put a cover screw and closed the flap. 

But now, one day later, I wish I had put a 4.5x11.5 . At first I was worried about lack of buccal bone but now I think it can accommodate a 4.5. So what should I do. Just wait for 6 month, with the current implant or replace the implant with 4.5 and go from there? 

Your advise is is highly appreciated. 



by Keyhan Alavian at Sun, Jun 4, 2017 11:52 AM

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Ho-Young Chung Replied at Tue, Jun 6, 2017 3:58 PM

Let me rephrase:

Primary stability is not necessarily a predictor of better rate of osseointegration.  Do I like achieving primary stability?  Absolutely, I sleep better at night.  But literature (not that I read a lot or solely depend on it) indicates that primary stability is really a "feeling".  I'm just the messenger.  I'm also referring to non-loaded implants.  



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Lonny Legault Replied at Mon, Jun 5, 2017 4:25 PM

I agree with Mark.  If it is just a "spinner" it can very well integrate if buried and no pressure on tissue above.   However, if it is a wobbler I would take it out.  A spinner and a wobbler are two very different things.   a wobbler is a spinner that if you took an explorer and put it inside the implant and pushed lightly it moves side to side,   I take these out, or try to go to the next size implant if possible.  

I respectfully disagree with Ho- Young,   I believe an implant with torque 30nm and above have a significantly better rate of integration than a spinner implant regardless of being buried and allowed to heal.

Hope that helps.



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Ho-Young Chung Replied at Sun, Jun 4, 2017 12:51 PM

Hi Keyhan.  Please attach PA taken in day of placement.  Having said that, I would leave all me the current fixture and allow it to osseointegrate.  Primary stability is not a predictor of whether a fixture will integrate as long as you bury the fixture and obtain tension free closure.  If you remove the 4.0 fixture and replace with 4.5 fixture, it will likely spin again.  

Ho-Young Chung 

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Mark Kwon Replied at Sun, Jun 4, 2017 12:50 PM

Depends on the "fit" of the spinner. 

Even if the torque is inadequate, the fixture fit is precise to the osteotomy without "wobble ".  Most of the times , will integrate in few month (~4month), as long as soft tissue dont open up and no pressure on the tissue.