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Failing Implant Treatment

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Posted on 08.08.2012 09:44 AM By scot mardis In Failures

We extracted 4 in Dec-11 and grafted. Waited 3 months and place an OCO ISI one piece 3.0x12mm implant. It torqued in over 40ncm. We placed a temporary crown out of occlusion to progressively load. The implant now is slightly mobile, asymptomatic, and appears to be failing on the radiograph.
Diagnosis- was that the implant may been placed and the graft was not mature, it was bot in solid bone at the apex and became mobile as it was loaded.
Treatment: 1) remove the failing implant and place a wider implant, 3.7 x14mm 2 stage, and place healing abutement on and allow to heal.
2) remove failing implant, curretage, graft and allow to heal and come back in 4 months and place new implant.
My question is my diagnosis correct for the failure and is there any reason not to just remove the failing implant and put a wider one in?
Any suggestions will be greatly appreciated.

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9 Comments

omid moghaddas says on 08.08.2012 05:42 PM

well,the causes could be high torque,and the remodeling of a non mature bone graft after that.which lead to losing the bone to implant contact.
i think it would be better to wait about 2months after removing the failed implant and then insert a new one,instead of replacing it simultaneously.

scot mardis says on 08.09.2012 08:02 AM

Thanks-Scot

Robert Burstein says on 08.09.2012 11:33 AM

I usually wait 4-6 months. The implant being a 3.0 seems a bit narrow. I also like to use ridge expanders which tend to make the bone a bit denser. I would also be tempted to go immediately to replacing with a larger diameter implant if the surrounding bone looked good.

Simha Kukunooru says on 08.09.2012 04:52 PM

Dr. mardis, what kind of graft material was used to graft the socket?

scot mardis says on 08.10.2012 08:00 AM

It was a mixture of Puros and DynaGraft.D and the pt's blood. A one wall defect, buccal plate intact, covered with a collaplug and sutured and then covered with periacryl.

binh tran says on 08.10.2012 02:12 AM

I had two failed in similar way, upper first/second bi, the implants were 4.3 mm NBreplace. I think it's because the whole implant length is in the grafted bone and early loading on this bone => failure. I had more success doing two stages in the bi area. No problem in the upper lateral because I can go deeper and engage original bone at the apex! I may be wrong on this theory though.

scot mardis says on 08.10.2012 08:04 AM

I think your right ,that was my diagnosis for the failure, probably just did not get the apex of the implant into enough good bone to keep it stable. even though it torqued it well at placment. Thanks-Scot

Maurice Salama says on 08.12.2012 09:35 AM

I think remove and place wider implant immediately without any immediate loading or temporization. A 2 piece implant is suggested here preferably with cover screw.
Dr. Salama

Arash Aflatooni says on 08.12.2012 11:58 PM

I have had similar issues with other 3.0mm implants. I think in this case it's a combination of being puerly grafted bone and the threads on the 3.0mm design. I agree with Dr. Salama, place a wider implant and make it two stage.