Exposed Threads Case: What Kind of Complications Can I Expect?

How long ago was the implant placed? Is it integrated yet? What you probably should have done on day of surgery and once you noticed it was not seated fully is to remove the implant and re-drill your osteotomy to the proper length and reseat your implant. At this point I would not do anything. The risk of exposed threads is that it could harbor bacteria which could lead to peri-implantitis. Monitor your patient on regular intervals and provide adequate oral hygiene instructions. I can see your patient has subgingival calculus so his oral hygiene might be an issue you want to focus on.

Periodontal patient with subging calculus on the lower 6? Should treat this first prior to implant treatment. Were the two exposed threads on the buccal only? It looks like an 8mm implant which means biomechanically you have about a 6mm implant this increases the risk of failure from occlussal overload. Exposed roughened surface increases the risk of peri-implantitis and this is a periodontal disease suceptable patient. If this does go pear shaped this x-ray with calculus on the 6 will not do you any favors-if it got into a medico-legal situation I would actually remove and replace this provided it is early in the healing process and you can just back it out.

Considering the length of the roots on adjacent teeth suggests that probably patient has a strong bite force, with that reason in mind and less than 10 mm in bone I recommend that u remove the implant ASAP, it is a Definate failure to me. U have enough lenghth to place longer implant so y take the risk?

I agree that the implant should be removed and replaced as soon as possible with a longer implant. It looks like there are a few mm of space above the mandibular canal. Otherwise, the current implant will eventually fail. I also agree that the periodontal status of this patient should have been optimal prior to any implant placement. It seems to me that you have violated a few of the "implant basics" and could use a whole lot more CDE on dental implant surgery, etc. My guess is that you are a GP with little implant surgery experience, based on your question and not knowing how to handle the complication. It also appears that the surgery was not guided by a Dentascan or 3D imaging, as a longer implant would have probably been chosen from the very start!

Based on the widened PDL spaces that I see on the teeth mesial to the implant, I would conclude that there is a strong occlusal etiology in this case. In addition, there is active periodontal inflammatory disease. I would strongly suggest that you control both of these factors, and only then, definitely place a longer implant that can withstand any parafunctional forces that exist (including the fabrication of a night guard).

First, these posts ripping on this dentist is uncalled for. If you want to get on a soap box and preach then do not do it on this site. A dentist asks for advice and instead gets a lecture on being a newbie and getting more courses. I can tell you first hand that sometimes things happen and mistakes are made. Maybe the implant was placed and patient released before seeing the xray. Maybe patient does not have enough money to do a deep cleaning right now but will do in future before crown is placed. Also, I come from a family of lawyers and can tell you that the patient might not want to go thru the "trauma" of having it removed and redone. Should it be redone...of course, but that does not mean you will not be sued either way. What needs to be done is have a discussion with the patient and discus all options. Then go from there. But lets stop insulting dentist on these boards. I am new to this forum and this is the second thread I have read and come across the same speaking down to the author of the question. I love to see these type of questions because I have no questions when everything goes well.

I placed an immediate implant in #8 with immediate load.After 10 days pt. returns with a lot of gingival swelling on the facial surface of #8 Looks like a possible infection of gingival tissue. Pt placed on antibiotics again and peridex rinses. Any ideas on what would cause the gingival irritation and what should be done.

As long as the implant integrates, it will be fine. Next time, GRAFT the patient prior to or during the implant placement, which requires more training and the ability to achieve tension free closure. While you could have placed a longer fixture, I am finding myself gravitating towards the 7-8 mm long fixtures more often these days, especially as the literature seems to defend their use (Fugazzotto, Shorter Implants in Clinical Practice: Rationale and Treatment Results in a single tooth replacement scenario, JOMI, May/June 2008, 23:3). I have no problem using a 7 or 8 mm blasted, etched (SLA) fixtures to replace a single tooth. By the way, there are other legitimate reasons to use a shorter fixture besides avoiding vital structures, such as improved fixture angulation by avoiding concavities, and ability to remove the fixture without destroying a greater area of bone. These arguments were nicely presented at the AO meeting in San Diego. In any case, after healing, place an appropriate prefab abutment on the implant, torque it to manufacturer's spec, and prep the abutment AND implant along the facial aspect to create a very light chamfer or other readable margin. Do not prep the screw access hole to the point of hitting the screw, and I advise doing as much prepping of the abutment on an analog holder outside of the mouth. After finalizing the prep, re-torque the abutment to ensure the vibration did not loosen the screw. Prepping the fixture is no problem. In fact, many one piece implants, such as those promoted by Hilt Tatum are meant to be prepped. Then take a normal crown and bridge impression. Do not pack cord. The hardest part of taking an impression is capturing the margins. Make an acrylic "impression" of just the abutment and facial margin as if you're making a temporary. It is very important do not allow it to lock onto the abutment. You will have to add acrylic to the coping multiple times to adequately capture the entire margin. Then, seat the coping onto the abutment, ensuring you have adequate clearance from the opposing teeth, and take a pickup impression. I always take full arch impressions for any implant case, making sure to use pvs tray adhesive. Finally, make a temp for the patient to prevent drifting. Place a cotton pellet and/or rope was in the screw access hole and deliver the temp with temp-bond mixed with vaseline, about 50:50. Instruct the lab to make the crown as usual, avoiding any crazy cantelevers or ridge lap style extensions. On delivery, you will likely have to anesthetize the patient in order to properly clean up the cement. In the future, always give your patients the option for achieving optimal results, even if you can't do the procedure. It is only fair to them. Most of the time, patients will elect to avoid extra costs and pain (grafting is fairly uncomfortable when done properly/adequately), and healing time. Compromises are inevitable, but it is your duty to inform the patient of these compromises before they happen. God bless.

Kor May is 100% correct, why do dentists feel they should be free to rant at someone who is asking for genuine advice. Based on my experience (7,000+ implants and a full-time implant referral practice for many years) together with the literature, exposed threads (on a machined surface implant) do not increase risk of failure. So there is a little calculus on the adjacent molar - big deal. If the implant you placed is solid, and based on your x-ray it looks fine, leave it and move on. You were right to ask the question, but this is not a case where you should be digging out the implant. Any sensible risk/benefit analysis would tell you to leave well alone. Good luck!

Yes a longer implant would have looked better on the x-ray film. If integrated and looking healthy at uncovering restore with a narrow occusal table and a light bite with function only in centric and not in excursions. It should be fine.

Obviously sort perio out pre implant in teh future! If the implant bottoms out before reaching teh crest: -wind out -re prepare site toi full lengthy carefully obviously with id close -bone tap -then re insert -never over torque ie over 40ncm or leave threads exposed as its a short implant most likely it will be absolutely dandy.

Right on John and Kor.....docs please leave your higher than thou and uninformed judgments to yourself. Mistakes happen and this isn't even a big one, if at all. As John said, so some threads are exposed, so what. The thing is solid, patient is comfortable. Load it, inform patient of possible future issues (as there are in ANY case) and move on. Increasingly, crown to root ration is being found not to be a major consideration, if at all, with regard to implants (as seen with thousands of long standing, ultra short Bicon implants success). There is no PDL to consider here. As long as the implant and restoration are not taking more than their fair share of occlusal force, this implant should last for years and years.

Dont fret, the implant will integrate, the threads may be exposed a bit, if so just polish them to a high shine. If you are really worried, do a screw retained acrylic provisional, low at first and add a bit of composite in 2 or 3 stages over a period of a couple of months to bring into full occlusion to train the bone. It will be fine. I would recommend a good hygiene treatment though ;-)

I don't see why a few of you posters are getting so upset because a few of us other posters are trying to educate the Dr who started this thread. I do agree that we need to be mindful of how we write our remarks so that they can be taken as "constructive criticism" and can be useful for learning. In this particular case, I do think that the failure to treat and possibly to diagnose both periodontal disease as well as primary occlusal trauma are EXTREMELY significant and relevent to the long term survival of the implant in question. Whereas I agree with several of you that a few exposed threads may not be an immediate problem, I must express my concern for the long term result. When implants such as this ultimately fail, there is a considerable osseous defect left behind and then the patient is worse off than he was when he originally started this treatment. We must try not to forget the wise words of Hippocrates..."above all else, do no harm." If this implant fixture already has 2 strikes against it (and who knows what other compromises exit, such as systemic diabetes, or is the patient a smoker, or is the an adequate band of keratinized gingiva on the buccal aspect?), shouldn't we be concerned with more than the fact that the fixture is currently stable? I haven't placed thousands of implants like some of the previous posters, but I have seen many...actually, too many...implants that have failed after being in the mouth for a very short time. Again, in this case, since there appears to be adequate vertical height above the IAN canal to place a longer fixture, I sincerely believe that it is in the patient's best interests to remove the present fixture, graft the site like an extraction site and go back in 3-6 months, and place a longer fixture. This is what I would want in my mouth. What would you want if this situation existed in your mouth??

Hello Fellow Colleagues, An interesting situation. I do not know the status of the rest of this patient's dentition;however, the radiograph is very telling ... It puzzles me when I try to consider what it is that motivated the placement of this implant. Respectfully, I will say this, there is mild to moderate chronic periodontitis here. What happened to pre-implant diagnostics and preparation ... the literature has abundant evidence-based articles on this issue. When I see dentistry like this, I really ask myself a ton of questions. To my dear colleague who started this question, I wish to ask you this, with utmost respect, do you know what you are doing and why you are doing it? This is a very simple case ... and it is compromised right from the start ... because of a lack of proper diagnostic, prosthetic and surgical protocol. Respectfully, Good Luck

ummm, I think protocol states you need to S/RP first before placing implants. Why did you use such a short implant? You definitely had room to place a longer one. If it is hasn't integrated yet, take it and place a longer one

Obviously this is a poor performance that should be avoided! the question that as been asked should not be answered at all because no protocol that i know was followed here bad dentistry should not be rationalized .nevertheless I'm sure that we can agree on that threads should not be left exposed above the crestal bone and thats purely evidance based detistry.SORRY

If this is left alone the chances of it failing are high. The advice given regarding perio, occlussion, and covering the threads Is correct. It's not holier than thou it is just the facts. Learn from it or stop doing implants. Patients have a right to a certain standard of treatment and this case doesn't meet it. It maybe very simple to back this out and replace if it hasn't integrated.

I would not have placed a gingival former but a flat gingival screw and placed a particulate graft with a closed flap. Thataway bone may grow over the threads by uncovering. Also did the adjacent third molar cause difficulty in accessing the site? I have often seen a few exposed threads heal over if the area is closed primarily. Just looking at the film, it's not so much that there are exposed threads, but perhaps there was haste to perform the implant, calculus and a third molar which can harbor bacteria needed to be addressed first. It will probably integrate but there will be a hygiene problem in the future and having to remove a third molar next to an implant crown is tricky.

Question: Was this implant placed using a flapless technique? Best Wishes ...