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[Surgery]  Anterior Implant failing? What should I do?


 

Hi Mark
    I have an immediate implant case (#11), using an rp active, that had less than 20ncm torque/stability at insert, position looks good (placed zirc abut and took pa) so I buried it and tacked an acrylic pontic in place.  At 2 wk check, I took pontic off and had a peek at the top of the screw.  there is a slight movement of the implant.  no pain or swellling, soft tissue looks good.  how long would you leave this before checking again, or would you remove implant and fill in socket with bone and do delayed approach in 3-4 months?.  my thought was to leave for another month and check again to see if mobility still there.  bone grafting was done at time of extraction and placement using Raptos and Dynablast.  I guess I could take a ct scan in a month and check to see if bone all around implant.    your thoughts?
cheers,


by Mark Kwon at Fri, Jul 8, 2011 1:11 AM

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Bernard Jin Replied at Fri, Jul 8, 2011 3:20 AM

Hi TG, thanks for posting your questions and this case. When you mentioned burying the implant, I assume you mean removing the zirc abutment and placing a cover screw. If the zirc abutment was left - it could most certainly lead to non-osseointegration - as the abutment would be prone to movement. You can find a good reference by West & Oates -"Identification of stability changes for immediately placed dental implants" (Intl Journal of Oral & Maxillofacial Implants). The anterior maxilla is known for losing implant stability 2 - 4+ weeks after placement. If healing goes as planned - it should osseointegrate over 3 months. If I were treating this case, I would try not to disturb the implant at all over the next 12+ weeks (unless you actually notice pain, purulence, erythema, etc.) - because disturbing the implant may just be enough to tip it toward the non-successful side. At week 12+, I would revist the case with a CT scan and RFA (radiofreq. analysis). Just my thoughts. Bernard



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Mark Kwon Replied at Fri, Jul 8, 2011 1:16 AM

Good to hear from you! Hope all things are well. Here are my thoughts: 1. You did the right thing (ie. burying the implant): when you cannot get above 30n.cm torque, good to bury the implant 2. Unfortunately if the implant was NOT mobile at the time of placement, but starts to develop mobility after 2 weeks, it may not achieve good stability 3. The good things is that there's no symptoms or signs of infection 4. It doesnt hurt to wait another month to monitor - if mobility gets worse, i would take it out and socket graft and go back in few months ( I always recommend good allograft cancellous bone) hope this helps, take care, hope to see you at our next courses. - mark