Resurrection of an Implant Disaster

237 Rating(s).


Posted on By Howard Gluckman In Failures

THis Patient presented with a main compaint of an infection around an implant. The implant had been replaced twice already as a result of an infection and non integration. Examination reveals the total lack of treatment planning and care as well as total failure on the practitioners part to correctly diagnose the problem and then carry out or refer the case for bone augmentation. This case highlites the need for adequate training before one goes ahead with treatment despite this the practitioner has been placing implants for many years and therefore one has to question the ethics involved in this treatment outcome. A wake up call for all of us.




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29 Comments


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Howard,
Have you tried subnasal elevation with Densah burs?
This way you could possibly place a longer implant for better stability.
Mike


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Absolutely great and well managed all the way through to completion. Do you believe that the plates "Khoury" were KEY here? or would standard GBR or Sausage style technique have been equivalent? Any tissue added and in which sequence? Thanks Mo


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Mo I think that any technique that you use that works for you would work here. I believe it was the sequence rather than the technique. Obviously from my point I prefer the gold when I ma resurrecting cases like this as I do believe it is best for the soft tissue but I think as long as you could grow the bone you would be good


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Simply amazing result, very inspiring work. Thank you for the great documentation - learning!


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Howie. Exquisite case management! It is a "miraculous type" improvement. I couldn't help but notice the root proximity relationship between the implant and the distal bicuspid. Did the presence of the mesial screws have any impact on implant position? I realize I am splitting hairs, but that's what we do:-). Another great case my friend. See soon my friend. Cheers. Chuck


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Thanks Chuck I don't think it had anything to do with it other than I messed it up a little could have been better


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Howie, it looks so easy in your hands. Great case management and result!
The only one good thing is that inter-proximal bone was present. And all other points...penetration into nasal cavity, extremely long abutment, root, damaged adjacent tooth by purpose! incredible, horror...
Why have you waited for 3 months after implant extraction?
Wouldn`t it be enough to wait 4-6 weeks? Have you done something to close nasal cavity penetration?
Congratulations
Best regards
Snjezana


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Thanks Snjezana. The reason I waited is that I wanted the nasal communication to heal totally so I wanted complete bone healing here. Bone healing is incomplete at 8 weeks.


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Excellent !


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Howie; This patient is lucky she stumbled into your capable hands....well done. Mo


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Thanks Mo


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Howie not much can be said fantastic . couple of quick questions do you think the root fragment contributed that much or do you think more so the nasal cavity penetration I wonder if you stuck your finger in her nose if you could feel the implant? Did you remove the screws? Percutaneously? Where did you take the bone from ?

Cheers,

Richard


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Thanks my good friend. The root fragment was definitely the issue. WE know that placing an implant into the nose or the sinus will not have any impact on the integration. And yes the patient could feel the implant in his nose but only slightly. The screws remain until they become a problem either from a point of view of aesthetics or irritation and then a simple laser incision is used without any sutures. The bone is harvested form the Ramus


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Just a master case Howard,

Did the distal papilla just grown back on it's own? Did you follow the 5mm to bony peak rule?

Regards


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Great work master.


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Thanks you Ashok


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Antoni thanks for the kind words. Yes the as long as the bone is still there then it will fill in as prescribed by Tarnow in his study as well as the Salama Inter-proximal height of bone study.


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Howie impressive case with magnific resolution. Very tough to promise a 100% successfull recovery! You did it my friend.
The key factor here was ...a good diagnosis, and perfect planning execution. You are a Master on both fields. My compliments.
Jorge


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That is a huge compliment my friend coming from you. In this case I definitely did not promise anything other than we will remove the implant from his nose lol


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Howie -great answer I only asked that to stimulate conversation about the nose and the fact that it iappears to be close to the turbiinate iand I was just wondering if around sinus season it would flareup. I had a feeling you took it from the ramus but I just wanted to see if you know maybe you had New palatal plate technique ...

Cheers my friend

Rich


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Rich he did not mention any issue with the nose at all other than when his finger went up there is was palpable


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Implant dentistry is now a common treatment modality in modern practice. Complications are relatively common particularly with the passage of time. These complications can range from relatively minor “maintenance” to life threatening “catastrophes”. Complications can be related to individual patient factors that affect the osseointegration process, component factors and procedural factors. Dental implant complaints are quickly becoming one of the most common matters for litigation in the dental arena. You can visit to a dental doctor as soon as possible. I think it will be good for you.


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Thank you for your comments Lucia


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KLS Martin
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