Can I load this implant?

Dear colleague, my suggestion to you: use a fancy word to educate your patients - and tell them that it is now a time for BONE TRAINING (simulate bone by loading, to facilitate implant osseointegration) - and make a provisional At prosthetic point of view, never forget to go with provisional at upper anterior region. what i am doing in similar cases: -provisional - soft tissue contouring to you, bone training for patient ->if you got the screw hall in esthetic part, just use composite, go to form exelence, rather than color ->show the patient what is going to look like ->you may have to thicken something or reduse (sorry, photos are made with phone, as i see) -if patient happy, you are happy with soft tissue esthetics, forms and functions - make a soft tissue contouring for min 3 weeks, max 1 month and 2 weeks ->individualize a transfer - take implant analog, screw the provisional on it -> sink it in impression puty -> unscrew provisional and place it in the mouth-> take a transfer place it on analog and puty complex-> individualize transfer with flowable composite, cure it fully, by curing oxide inhibition layer or polish it after that. if you are not happy with something, you are able to fix, just apply some composite -> place individualised transfer in the mouth on implant, take your loops (recommend), and take of composite at the level of soft tissue, to make your dental technician where the gingiva is. If you are using chair side cad cam, you are on your own, besause i do not know how it is working, for now :) choose abutmet materials wisely and you will be okay

Is the CBCT current? if so there is no osteointegration. One thing about peri apical films, one can't assess the buccal plate. If the Cone beam is accurate then when you open the flap and place the impression coping the implant will come out. Looking at the angle of the implant it is not restorable. Most likely there will be a significant defect when the implant is removed patient will need grafting in an esthetic area. One Pearl when a canine is impacted the alveolar process does not develop completely and this lack of fully developed crest need to be taken into account. I advise referring this case it is compromised.

Nothing is said about the implant clinical mobility/stability which is crucial as the implant is surrounded with grafting material mostly. If it's even a minimally mobile, I would refrain from proceeding.

Hi Satish always difficult removing an impacted Canine , place and graft at one go . I have just placed a500 case study on this protocol and understanding materials and protocols is important ... I think you have too many materials here and maybe missed getting graft stability which is the key ...... motion inthe particles could led to Mesechymal cell differentiating to fibroblast .....hence what you have here is a lot of granulous tissue with some particles in the mass as see in your PA .... This needs a re-graft or to start again .. Just some ideas Peter

in cases like these I rememder Ed Rosenbergs advice......do one miracle at a time ......and to remove the impacted canine first ,augment,for enough bone and the implant later

Thank you all for your valuable comments. Today I exposed the implant and the implant was stable and covered by bone all around the cover screw. Abutment was placed and finger torqued to maximum,still stable. Is there anyway to upload photos for further comments. Thank you again everyone!

Keeping fingers crossed now.

You may it tried to many procedures into one visit. You mostlikely will have to vemove the implant and regraft. Mp lace the implant later. The maxillary cuspid is a difficult site.

I suggest to always line up the platform with the adjacent teeth when viewing from the occlusal. This will usually result in the implant being in the correct F-L orientation. According to your CBCT there appears to be poor integration. One should probe the osteotomy sites after each bur or prior to placing the implant. If you feel a perforation then act accordingly. I'm a bit confused. I do not see this implant in a cuspid site. Please elaborate!

I suggest to always line up the platform with the adjacent teeth when viewing from the occlusal. This will usually result in the implant being in the correct F-L orientation. According to your CBCT there appears to be poor integration. One should probe the osteotomy sites after each bur or prior to placing the implant. If you feel a perforation then act accordingly.

Hi, I was following your case. want to know that have u loaded the implant. how is it after loading. can u share some pics. Thx