Topic

[Surgery]  Failing Implant


Hello everyone.


I placed this implant in February of 2015 with no complications.

Radiographs are Feb, June, August and October.


I did take the course for implant complications and management.


The tooth is in implant protected occlusion. It was a cement retained restoration. I only use screw retained whenever possible.

I realize cement may be to blame.


My plan is to access the screw, remove the crown and raise a flap on the buccal. I have the NiTi brush and ability to utilize PRF.

Can somebody walk me through what possible diagnosis and treatment is. I realize the imlpant is a shorter then ideal. There is no mobility or purulence and probing indicates DL, DB, B are 6-7mm probing depths.


I would appreciate any comments.


Chad Denomme


by Chad Denomme at Wed, Aug 24, 2016 12:30 PM

1062 Views | 7 Replies

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Chad Denomme Replied at Fri, Sep 2, 2016 6:43 PM

Ok mark thanks so much. I reviewed the efr removal for nobel WP but took bad notes can you outline that protocol Chad



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Mark Kwon Replied at Fri, Sep 2, 2016 6:30 PM

dear chad, thanks for the post. we can all learn from cases such as this. Happens to the best of us. my action in orders: 1. CT scan update to determine available apical bone 2. prior to implant removal, you may want to consider mesial slenderizing of ##36 area to give yourself better interproximal contact points , ease of access and ultimately minimize food trapping interproximally; Food trapping may have aggravated the situation as well. 3. also check soft tissue condition such as minimally attached gingiva or frenum pulls; these conditions can also affect long term bone maintenance 4. as far as removal is concerned; EFR-kit from hiossen should work well; I've done the compatibility test between NB fixtures and EFR-kit (easy fixture removal kit); so just refer to that. 5. if you have enough apical available , you can put either 4.5 or 5.0 diameter fixture at the same time; however, it will depend of classification of the bony defect; if buccal and lingual plate is gone, you are better of at your stage to just socket graft using f-prf (yes, use sticky bone protocol using 2 white 2 red spin and mix w cancelous with L-prf and f-prf to activagte the graft to become hard); this should help to regain some of the vertical losses. If the bucall and lingual plate is intact, you can put the implant and treat the remaining defect as socket graft; you can place helaing abutment with surederm with tissue punch on top and tuck it under the proximal tissues and suture up hope this helps, - mark



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Mark Kwon Replied at Fri, Sep 2, 2016 6:29 PM

dear chad, thanks for the post. we can all learn from cases such as this. Happens to the best of us. my action in orders: 1. CT scan update to determine available apical bone 2. prior to implant removal, you may want to consider mesial slenderizing of ##36 area to give yourself better interproximal contact points , ease of access and ultimately minimize food trapping interproximally; Food trapping may have aggravated the situation as well. 3. also check soft tissue condition such as minimally attached gingiva or frenum pulls; these conditions can also affect long term bone maintenance 4. as far as removal is concerned; EFR-kit from hiossen should work well; I've done the compatibility test between NB fixtures and EFR-kit (easy fixture removal kit); so just refer to that. 5. if you have enough apical available , you can put either 4.5 or 5.0 diameter fixture at the same time; however, it will depend of classification of the bony defect; if buccal and lingual plate is gone, you are better of at your stage to just socket graft using f-prf (yes, use sticky bone protocol using 2 white 2 red spin and mix w cancelous with L-prf and f-prf to activagte the graft to become hard); this should help to regain some of the vertical losses. If the bucall and lingual plate is intact, you can put the implant and treat the remaining defect as socket graft; you can place helaing abutment with surederm with tissue punch on top and tuck it under the proximal tissues and suture up hope this helps, - mark



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Chad Denomme Replied at Wed, Aug 31, 2016 3:03 PM

Glenn thanks for the reply. I will test with the ISQ. Are you just using the value to check how difficult removal may be? I have the Hiossen kit for removal and I see for NB Replace WP I see TS 5, or TS 4. Maybe you can tell me what that means as I took the course over 9 months ago. Once removed curettage of the site is very important then I plan to place a 5.0x10 Hiossen ET3 fixture in the same site. I will also use 2 red , 2 white spun at 2700 RPM for 12 minutes for sticky bone for grafting to fill in all defects. Do I just place PRF membrane draped over grafted area and tuck it under the lingual. Do I need surederm here? Thanks again Glen. Chad



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Glenn van As Replied at Sat, Aug 27, 2016 12:02 PM

Hi Chad...I think that using the implant removal kit wil work on this. Do you have an ISQ unit at all. If you remove the crown by drilling a hole in the occlusal and removing it first then check the ISQ to see what it is. Mark Kwon has worked out a guide for using the removal kit from HiOssen within Nobel implants. Do you have the HiOssen kit or another one. I actually like your plan but I would also look at the CT to see if you can put in a "rescue " Implant being a 6 mm. Sometimes a longer will not get a bite. One cool thing with the HiOssen kit for removal is that you can get the implant out without doing a tremendous amount of damage to the bone. I just took out a 3.5 mm implant that had fractured ( the curse of van As) and put in the exact same size implant same length and got primary stability....amazing but true. I think your plan is best and the likely cause was a combination of the healing cap not being seated, this caused loss of bone early and then also the cement may have exacerbate it. These cases test your gut lining and your pocket book....we all have them..myself included but the less we have the better. Hope you are well and show us the follow up...I think it will be spectacular. Glenn



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Chad Denomme Replied at Thu, Aug 25, 2016 2:45 PM

Thanks Ho Young. Here is the PAN, not recent of course. Plan is to remove implant with removal kit, trephine a bit if necessary. Implant is a 5x8 Tapered Groovy. Curettage and irrigation of the area, Place a new 5x10 or 11.5 hiossen ET3. CT pending. L-PRF and bone with regular PRF membrane and surederm placement. This is my first removal. Any helpful hints moving forward? Chad Denomme



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Ho-Young Chung Replied at Wed, Aug 24, 2016 1:24 PM

Hi Chad, It appears to me that your healing abutment wasn't fully seated. Based on PA with impression coping it appears to me that you had some crestal bone loss prior to insertion of your final crown. About half of your implant threads are already exposed and your most predictable solution at this time may be to remove and graft (and place another implants either immediate or in the future depending on your experience, comfort level, and skill). Ho-Young