Implant Loss Secondary to overloading?

157 Rating(s).

Posted on By R. Terry Councill In Failures

65 y/o presented with only one lower incisor which was periodontally involved and mobile. This remaining incisor was removed and two 3.0 Astra implants placed.
There was a a Class 2 defect associated with the extraction site. The defect was within the boney housing and was grafted with Sticky bone and covered with a
resorbable collagen membrane (Cytoplast). The membrane was stabilized with the temporary abutment screws. Primary closure was not attained, however the site was
covered with fibrin clots. 6 weeks later,patient presents with report of loose implant. He had been eating corn on the cob. Mobile implant removed. The sound implant also had a totally loose abutment screw. Noted huge Class 3 vertical defect. Grafted with Ti-Mesh, Sticky bone with Miner-Oss, multiple fibrin clots and primary closure. Failure considerations include failure to adequately torque abutment screws, failure to completely remove granualtion tissue, occlusal stress too soon, All 3. Thoughts and comments.

initial surgery
Preop CBCT

Immediate PA and 6 weeks later
TiMesh and closure
Add to Favorites
Add a comment to the discussion on Implant Loss Secondary to overloading?

Upload photos
1.  Photo Title:

2.  Photo Title:

Would you like to follow this post?
Case has been added to your favorites.
Case has been removed from your favorites.
Thank you for your input. Your comment has been posted.
You are now following this member. You will get notified on any new topics posted by this member.
You are no longer following this member. You will not get notified on any new topics posted by this member.
Edit Comment
1.  Photo Title:
Current Image:   Delete Image
2.  Photo Title:
Current Image:   Delete Image
Comment has been updated.


Terry, thanks for sharing. It is in these cases we learn the most. I think after your regenerative approach here you should be ok BUT....I think you may have been "pushing the envelope" here in the original case design....immediate placement, grafting and loading in an "open" environment. This lesion looks like classical post op infection and granulomatous tissue invasion....from now on...."One miracle at a Time" Dennis Tarnow.


100% agree with Maurice wise comments


In my office if a patient really wants an anterior immediate load temporary I will do it in selected situations but the financial monkey is on their back if it fails. If it fails they have to pay me to remove the implant, graft the site, place a new implant only this time buried, no argument. When they have significant money to lose by not following instructions they're much better about paying attention and consistently following instructions. In this case it appears that the abutment screw in one of the implants came loose, which put the entire incisal load for that double temporary on one 3.0 implant. Couple that with a patient who's really overloading the one load bearing implant eating corn on the cob and the bone disappears. That's my thinking.


Terry, great post!
All 3, I don`t believe we can make out one factor responsible for the failure.
Initial stability: 59 ISQ; 3,0 implants...
Infection: as Dr. Salama pointed out
Immediate loading (provisional) is nice and convenient for the patient, but often it is better to close and wait. Or put healing abutments and wait.
Thank you so much for sharing! We see too much successful cases that lead us to do many miracles at a time.
Best regards


Hello Terry,

I would like to congratulate you on the management of this complication. As Dr Salama pointed out, I believe your result should be awesome here. With that said, IMHO the type of defect you had initially around your implant requires a closed healing environment and some sort of barrier to contain the graft. You may have push the envelope a bit too much.
Again I have to commend you on the way you recovered this case my friend.



Thank you all for your comments. From now on One Miracle At A Time.


Terry, thank you for sharing.
We always learn the most from our failures.
IMHO it was the temporaries that caused this problem.
The initial surgery looked great. I agree with the panel about closed healing environment. There is simply not enough space for the temps. There is no way to seal the surgical site properly.
It looks like right incisor temp binds against the bone. With some bone remodeling it becomes loose over time even if you tighten it properly initially. Also in this case I would use lower turnover graft. Congrats on great case management. Future is looking bright!


Great point Mikhail. I've learned alot and I see that the provisional may have cause binding on both the soft tissue and the bone.