PET not going well. Now what?

88 Rating(s).


Posted on By Ben Lashley In Implants

This is one of my first pet tecnique cases. Have done 20-30 more since this and have had near 100% success. This one may have failed due to tecnique and the fact that the original temporary fractured two weeks post op. No matter, here we are. Implant is integrated and sounding by tapping shows stability. Tissue appears healthy with no exudate but probing reveals 5 MM pockets. Now what? How would you treat this case now that we have had a less than perfect outcome? I am hanging this out there for the world to see. I am hoping I and others can learn from my mistakes. Let me know what you all would do? Thanks!

placement
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temp
temp in place first day


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8 Comments

This appears to be a restorative zone complication. Need to get rid of the peak abutment and use smaller diameter titanium abutment with a reduced contour emergence profile.
May also need to reshape the shield to provide more restorative space.
Good luck


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I forgot to mention we are now 3 months post op.


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Hi Ben, I need to see more images: 1.- actual emergency profile 2.-actual CBCT image. Then, change the provisional, let more proximal papillas space! You said 5 mm probe...on mesial, buccal, distal?? I believe that if the implant is well integrated, this is enough. When we do immediate implantology, without SS, we also have at least 3mm probing....but we don´t usually test it. I don´t like a screwed provisional STRAIGHT to implant! You should use a MUA (multi unit abutment) and let the biologic width do the seal without connecting/disconnecting procedures!! Please post the images I ´ve asked. Regards Jorge


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Thank you Jorge and Filipe. I will include the original immediate emergence profile. The original immediate post op pa shows bone up to the collar of the implant. I don't have a new CBCT only the original pre-op CBCT. I agree with you and rarely remove my immediate temporary abutments because I want them not to lose attachment. I in fact will remove them once at the end of healing (3-4months) and build a final screw retained restoration at the same appointment utilizing cad cam so there is very little on and off of any abutment. This one may have failed due to the fact that the patient bit something and fractured my temporary one week post op. I left it alone for 3 weeks and went back in at the 4 week mark and made a new one. now we have this bone loss. The probing was to see if there was exudate, not a normal procedure for sure as you elude to. The 5mm was interproximal on the distal but again no bleeding and no exudate. I was fearing that I simply need to remove the implant as Filipe suggests. Fourtnuatly this is clearly a thick phenotype case and I should be able to remedy the situation. I feel i may need to remove the shield as well but I will save that for a clinical decision. If what I have provided alters any thinking please let me know!


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Ben thx for sharing the case! As Jorge said some couple more images would be nice. But IMHO the simplest and safest way to go is extract the implant & put another implant, i am pretty much sure that you will still be able to preserve the shield. As Chuck said, work a little bit on prosthetic space and you will do fine. I have several hundred of cases and in my experience, the few that failed were then in pretty good shape just by replacing the implant.


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The implant was too shallow perhaps? Seems like platform is at the same levels as interdental bony peaks? Keep us posted


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Would be concerned with this implant design and PET as it has a pronounced collar making it more likely that there is pressure or it has caused mobility of the shield.....The coronal aspect appears to be an issue. Would consider removal of temp and re-evaluate shield and graft if needed around shield if still stable. Dr. Salama


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Consider Vertical Root Fracture of the shield


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