Early Dental Implant Failure: Clarification of Possible Explanations?
Dr. B. asks:
I have been confronted with a case of early implant failure resulting in the removal of the implant, I am trying to figure out what went wrong with a case that I just did which failed immediately.
My understanding is that there are two possible explanations here. First is the potential of “burning the bone”, i.e. I may have overheated the bone during the osteotomy phase creating heat-generated bone necrosis. Another possibility is that I contaminated the osteotomy site or the implant and caused an early infection. For each explanation, I would appreciate some clarification.
In regards to “burning the bone” are we talking about too low RPM’s, too long contact (time) of the drill against the bone, using room temperature water to irrigate instead of chilled water, a dull osteotomy drill, etc. External irrigation of the osteotomy bur does not really allow much irrigation into the osteotomy so do you pump the drill in and out with only seconds of contact?
With regards to contamination , what about flapless when the crestal tissue is lacking ? What about placing ophthalmic gentamycin on the implant itself prior to insertion? What do you think?
Thanks.
23 Comments on Early Dental Implant Failure: Clarification of Possible Explanations?
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Greg Steiner
7/18/2011
Dr. B
please give us some more information. Any significant health issues such as smoking? Was the site grafted prior to implant placement? Was it an immediate implant? Were there any bony defects? Was it immediately loaded? etc. Greg Steiner Steiner Laboratories
Bruce GKnecht
7/19/2011
Burning Bone could be a dull bur,pressing to hard adn long to create the osteotomy, or not enough water irrigation. I agree it could be a contaminated site or impant. It could be no primary fixation. It could be a habit by the patient. It could be a frenum pull. Heck do not dwell on the negative adn place another and move on. We only learn from our mistakes and not our successes.
Steven
7/19/2011
Again, we need some more information. What was the healing like at first post op appt? Was there any evidence of infection? If not, I would rule out infection as a cause of the failure. Secondly, tell us alittle about your osteotomy technic. If you were dealing with D3 bone, which is often the case in the maxillary premolar area, then it is unlikely that you "burned the bone", unless you failed to use any irrigation. I highly doubt that you could attribute this failure to not using refrigerated irrigating solution or for that matter external rather than internal irrigation.
Dr. Wolanski
7/19/2011
Everyone is asking good questions to help you. Other things we would like to know are, what was the torque you inserted the implant to?, where was the implant placed?, what kind of implant was used?, Are your drills new? how long be fore you removed the implant?, did you see any problems at 24 hrs post op?, do you have x-rays. Without more informatioin any answers are kind of spculative. It is amazing how a retry will simply work.
Dr. danesh
7/19/2011
That is a good case, but to specify ,what is the reason behind of this failure, we need to know a lot of informations, but as a rule the ff. might affect it,
-dry socket after osteotomy( no bleeding ).
-contamination
-powdered gloves
-lack of primary stability
-presence of cyst
-periodontitis
-uncontrolled diabetis,and some systemic disorders
-overheating
-over torquing the fixture, causing blood disruption
-trauma to the implant
and many more...
please explain some more.
Pankaj Narkhede, DDS; MDS
7/19/2011
If It is not an anterior - I would blame smoking. If the patient doesn't smoke
hmmmm!good question :-)
Dr.B
7/19/2011
Some comments mention torque. Do we know for sure that primary stability is a factor in implant failures. I don't know of any studies. While I personally feel more comfortable with higher torque, I'm not sure we have the data. I had many implants with poor primary stability integrate just fine. Just being the devil's advocate here.
Dr.B
7/19/2011
By the way, my previous comment is also true for pressure necrosis.
Robert J. Miller
7/19/2011
All of the previously mentioned sequalae may contribute to early implant failure. However, several extremely important parameters were left out of the discussion. What type of implant were you using? Was this an extraction site or healed bone? What was the torque value as the implant was being placed? Without this additional information, any speculation on why this particular case failed is just that - speculation.
RJM
Baker vinci
7/19/2011
Buy the book first, then place the implants! The question should be edited! Bvinci
sunil
7/20/2011
early failure usually go the surgical failure, but firstly weather the site was free of infection,patient systemic history, local condition of the bone, bone quality, patient's habit like smoking drug history, old drills, chilled saline usage, type of the implant used( single stage or two stage), primary stability,torque used, soft tissue coverage, any complication during surgery like bony dihesence,early loading, contaminated implant surface or the site due to infection.so many points to be checked to name the early failure
Fredrick Shaw DDS
7/20/2011
There is not enough information in your question to answer the reason why that implant failed. We can pontificate all day long with plausible and even likely reasons why something behaves a certain way.
Two wise men each led to an elephant but at opposite ends where asked to describe what they had found, each replied it must be an elephant.
Baker vinci
7/20/2011
I never saw the elephant. Bv
gary omfs
7/20/2011
i've had about ten consecutive failures in healthy non- smokers with southern implants type IA-LH and (almost) none with Straumann. When I asked the distributor how come, they sent me narrower drills! It cost me a lot of money and effort to set this all straight.
Take home message: stick to the original.
Fredrick Shaw DDS
7/20/2011
I failed to mention both of the wise men where blind and had to feel their way to arrive at their conclusion. Had they had vision, a tactile approach would have been unneccessary. Point being the feeling your way through approach covers the many things that may have gone wrong with this inexperienced ill prepared nebbish. Regardless, reading the book is a pre-requisite not to mention comprehension.
Baker vinci
7/20/2011
Uh, that pretty much sums it up, I'm my opinion! Bv
Baker vinci
7/20/2011
Gary , I couldn't agree more. I have a fly by night company beating my door down, because their implants are cheaper. Won't mention the name, but they are cheaper , in every since of the word. I will go with the more expensive implants,and damn sure let my patient know. This is why I will never place a mini implant, unless prescribed by an orthodontist. Bv
Dr. Dan
7/22/2011
How soft was the bone and was there primary stability? Are there adjacent teeth with root canals or need root canals? An xray would have been helpful.
Baker vinci
7/25/2011
Dr b. With all due respect, while waiting for a scenario that is appropriate for this forum, I continue to re- read some of these blogs. When reading your initial problem, it concerns me that you don't have a grasp on some of the most fundamental principles . I beg you to get some Intense training in some of these principles. This is not the place to generate acumen. When done correctly, simple implants are well within the scope of your practice, but remember, your patients deserve the best. With the questions you pose, it would be hard for me to believe you are ready to place implants. Dont be fooled by the company that suggest mini's are a compatible alternative to traditional implants or that you can obtain competence in a single day of training. Sorry, if this seems harsh, but I am trying to be as constructive as possible. If a trial attny were to get a hold of your question, you would find yourself in a mess! With RESPECT. bv
Richard Glick
12/26/2011
Does anyone have an answer why an implant fails afte
Richard Glick
12/26/2011
Does anyone have an idea why an implant fails about 2-4 weeks after
Placement. Bone was type II and placement firm. This has occurred several time and is extremely frustrating.
Robert J. Miller
12/26/2011
While almost every conceivable aspect of healing has been covered in previous comments, not once did anyone question the type of implant that was placed. Any of the preceding sequalae can affect implant outcomes, but the chances of any of these occuring on a regular basis is remote. The previous question is "why do implants tend to fail at 2-4 weeks"? The real answer is in the implant design. Certain types of macroarchitectures have a much higher failure rate than others. Most of the big companies today have designs that are anywhere from 15-40 years old. This represents "engineering-driven" rather than "biologically-driven" considerations. There are companies who are newer on the scene that reflect that type of thinking with success rates to match their rhetoric. Time to reevaluate your paradigm.
RJM
Richard Glick
12/26/2011
Thank you for your response. As a periodontist I use the implants that my referring dentists feel most comfortable. It's usually 3i of Keystone, both of the tapered design. One thing is for certain, when replaced, they most certainly integrate
