Two imediates, one failure

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Posted on By Ben Lashley In Implants

This 66 year old female presented by referral for two immediate implants in 12 and 13. The phenotype was thick and good buccal bone was present so complete extraction was elected vs PET. Pinpoint exposure of the sinus in 13 was noted during placement so a collagen plug was used prior to implant placement. Radiographic evidence of proximity to root apex of 11 was also noted but no post op complications. Temporary's were bonded together. 10 day post op revealed no complications but 3 month post op showed failure of 12 by circumferential down growth of soft tissue. I have always thought micromovement or microtrauma was the culprit of this. Perfect bone growth around this except for the "threads" of soft tissue. Upon cleaning of the site, cementum of 12 could be seen. Osteotomy was re-directed and another implant was placed in fresh bone.

What are the causes of this type of failure? The two temps were fused! One is perfect the other was a very late failure. How can I avoid this type of failure in the future? Fortunately this is near 100% success when re-implanted. Was the grazing of the cementum at the apex the problem? I think not but I question. Wisdom and critique appreciated.


pre op PA
temp removed

implant removed. Note threaded soft tissue
fresh socket after explantation

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Here are a couple more photos. One pre-op noting bonding of temps. The other is post op after the new implant was placed and custom temporary re- inserted. They were not bonded together again.

Pre Op bonded temporary's


post op


Ben, not withstanding the proximity to the root of #12, it seems to me as you did everything well. I don't know what you can change to eliminate the chance for this type of failure. Good luck.


Thanks Dr Salama. Always a head scratcher when it happens. Easy to question ourselves and if we are missing something someone else knows the answer to. Appreciate you looking.


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