Mobile implant removed: most predictable procedure?

Not sure what I'm looking at but if that implant is 31 I would remove it also, and refer the patient to someone who knows how to evaluate healthy bone and graft the sites after controlling any pathology or granulation tissue, let them place the implants and you should restore, be sure to make them a surgical splint. Good luck.

If this is after a week the most likely scenario is that 31 is lost too, and I would venture a guess, overheating... Let the sites rest, control any infection if present, wait and replace implants in 12 to 16 weeks. NO grafting now, if it was overheating, you wont get good results. best of luck

It would be nice if u publish the pre operative and immediate post operative radiography also, I notice may be by mistake u have made oversize osteotomy, but did not insert the implant at the preparation depth. You must try using torque ratchet. Moreover try to follow specific design of the Implant and drills. Now don't worry just clear the patient, and remove all the foreign material. Plan for a delayed implant. All the best

It would be nice if u publish the pre operative and immediate post operative radiography also, I notice may be by mistake u have made oversize osteotomy, but did not insert the implant at the preparation depth. You must try using torque ratchet. Moreover try to follow specific design of the Implant and drills. Now don't worry just clear the patient, and remove all the foreign material. Plan for a delayed implant.

CRS, I have to agree that the distal implant should be removed. To know what went on is a mystery and could be many reasons. I have been using Southern dental implants in molar sights and have had great results. It is not a beginners implant but it is great. You may not have the ability yet to place one of these and if you are asking in one week what happened, I would graft and wait for a nice site to place your implant.

As mentioned above, it would be most helpful to give advise when a preoperative radiograph is presented. From what I see in the film supplied, this patient has multiple problems....and these problems should be addressed before attempting to place implants. Why were the natural teeth lost? What is the age, sex, health of the patient? Is this person a smoker? Is there evidence of periodontal disease? My advise is to thoroughly examine the entire oral cavity; do a complete cleanup; .....change the patient's attitude with respect to good oral hygiene. Once this has been accomplished, place the patient on antibiotics, open up a flap and completely clean out this area with scraping,( debridement), and washing with citric acid followed by a saline solution......close the tissues....allow 3-4 weeks to heal.....and any granulomatous tissue should have been sloughed off........then re enter, with a full thickness flap, and scrape the damaged bone to promote bleeding, and place any of the suggested bone grafting materials such as Bio Os, Allosorb,Ostigen, etc........harvesting PRF is an excellent way to provide growth factors , and use the Fibronectin and Vitronectin that is extruded when you flatten the fibrin clot to make a membrane.....wet your grafting material (s) with these fluids.....and after you have packed the particulate mixture into the damaged site, place the fibrin membranes, before you re-approximate the tissues, and suture . Allow 4-6 months for new bone to develop......it will not be necessary to open the tissues, so with a new radiograph or a scan, determine the amount of bone you have, make a model of the edentulous ridge,.......drill holes into the model where you would like the implants to be placed, and insert dowel pins or wooden sticks, and with wax or plastic, carve crowns...... the models could be mounted on an articulator to see the crown height space........a surgical guide could be made from this model.......and the holes can be placed to line up the implant positions...... In this matter, you should have created a healthy ridge, you have planned the prosthetic placement of the crowns, and you can now place the implants in the best possible positions.....not like before when you were drilling into root sockets that did not correspond to the proper placement of crowns........just think.... we are building structures in miniature....... we need to build on solid ground...and make good foundations to support the new future buildings.... a simple tip for you....buy an Ikea garlic press, that is made from stainless steel, sterilizable, and will allow you to press the fibrin clots into thin membranes to cover the graft........good luck.... we all had to start from the beginning, and this is how we learn. Gerald Rudick dds Montreal, Canada

The first step before attempting for anymore implant is to find out why the first one has failed. A full history of patient and pre-op and immediate post-placement x-rays are necessary. If all the local and systemic factors were ok when you placed the implant, a loose implant after one week is most likely the result of overheating. BTW, was it an immediate implant? Why the osteotomy of site #30 is so massive but in site #31 you placed a narrow diameter implant? It looks like that the #31 implant is sitting above bone crest on mesial and should have been placed deeper.

looks like 31 is failing too. 29 also seems to be periodontally affect. u need to re-evaluate your patient and check whether he is/was a good candidate for dental implants. my advise is to remove 31, clean and debride the osteotomy sites. if u don't have an infection proceed with bone grafting. Good luck

I don't think we should learn by experimenting on live patients, get some help and build on what you know first, restorative dentistry. Don't try to do too much it is not fair to the patient. Take it in small steps. I don't get how asking for help from an experienced colleague is wrong. One cannot do everything well, I fear that Dr Rudicks well meaning comments are well over this posters skill set and understanding. Sometimes the best advice is caution and knowing limitations. You can't learn this on a blog. No shame in great treatment planning a good surgical stent and great restorative. That's why a team approach is warranted. Do you really want to waste chair time and money redoing this stuff gratis? Not a good business model to experiment on patients. Thanks for reading.

In lieu of this situation, I would like to ask all my learned friends, the different techniques to remove failed implants, especially after a few months of their placement.

Here if serious about Implants get some good x-ray gear and good tuition with a solid mentor . As to removal if they have failed take out with your fingers if integrated but issue use Neobiotech kit quick easya nd relaible . Peter

We have updated this post with new case photos from the original submission. Please refer to the new case photos above in the case description. Thanks.

This case needs solid treatment planning as Gerald and CRS suggest. I would of started after the stent and mounting by extracting nd grafting the sockets. Give the site several months and place easy implants. The implants in the case presented could of been lost due to over heating of the bone or the osteotomy was not of sufficient width and not enough threds were holding the implants. I know one can cut down the crown and drill into the septum but I still worry about bacterial contamination from broken down teeth and decayed teeth. Then remove the root tips. Otherwise this is not an issue.