Had a Spinner with Zimmer Implant: Best Protocol?

Dr VD Bone cement and prescribing a biphosphonate may be this orthopedic surgeon's protocol for dealing with a loose implant, but I doubt it has any value here. A spinner is handled by going deeper (especially with tapered implants) or using a wider diameter implant. If you closed the surgical site, then you already decided to take a chance, and see what happens. There are occasions where the spinner implant will integrate, but it is not predictable. If you decide to take a chance on it, a longer than normal period for osseointegration is advisable. Good luck.

This is not a "spinner" just low primary stability was achieved , merely use a longer or wider implant or if you do not have you can place graft particles into the osteotomy. I am sure your case will be fine though as the bone will grow close to the implant. A spinner is when the implant rotates at the loading phase due to lack of integration and here removal is best. I am amazed at the orthopaedics use of bisphophonates though this shows our different approaches to oseointegration.

I had a similar situation but could not back out the implant so no option of wider or longer.

Actually, the term spinner is a fine way to describe an implant that simply "spins" and will not achieve adequate primary stability during placement.

was the implant spinning when you tightened the cover screw?if you have primary stability of 20 ncm,and CLOSED healing you can expect the implant to integrate,albeit your waiting period increases to 5-6 months.

I agree with most of the other posts. However I disagree on removal. If there is no soft tissue invading the site and the implant is in direct contact with bone the best thing is to leave the spinner for 6 months to continue osseointegration. This was the answer given to me by Dr Jack Hahn, and it worked. Good Luck

David Nelson, Your comment reminded me of a case that I did eons ago. I was using Steri Oss press fit implants at that time (a good system). I had one that was a spinner. I pressed it up against the wall and placed a dense HA in the remaining portion of the extraction site and fixated the implant.....resulting in a screaming success.

Was it a straight Screw-Vent or a Tapered Screw-Vent? Zimmer is still selling both. The tapered Screw-Vent with a soft-bone, hard bone protocol was developed in 1999 to overcome lack of initial stability. With the tapered implant in soft bone you need to stop at the intermediate drill and let the implant expand and compress bone as it is being inserted, thereby increasing initial stability. The VA Study conducted in the early 1990's using 3000 Core-Vent/Paragon implants including about 1000 Screw-Vents, showed that if you had a spinner with an HA coated implant it would still osseointegrate about 95% of the time whereas the then acid etched implants had a much lower success rate if they lacked initial stability. So if you place a Tapered Screw-Vent and it continues to rotate, it just means that the bone was soft and you have stripped the threads. If you can go deeper or wider to gain initial stability, your success rate with non-HA coated implants will increase. Definitely bury a spinner for a 3 month healing period.

Dear Dr.VD As a rull , upon drilling in a D4 bone [very soft bone] after the first pilot drilling most specially in max. post. area , I try to expand the site in order to achieve a denser bone then inserting the implant. In your case since zimmer swiss plus is an one stage implant, so you couldnot cover the tissue over it, w/c can decrease your success rate, (a disadvantage of using zimmer. I suggest you wait for 6 months befor loading. GOOD LUCK.

how about the safety of drug regime of Ostoefos [Fosamax, alendronate; a bisphosphonate] for three months. has anybody tried it and any study related to this

Don't worry. It will work. As long as the implant wasn't moving freely and you had some minimal stability it will osseointegrate. I have had that happened to me a few times with other implant systems and they all integrated, given there was reasonable amount of bone around the area. I'm surprised that the Zimmer implant was spinning. Usually they have very good grip and aggressive threads. So now the questions is whether your site was good to place an implant or maybe you should have staged it.

Backing the implant out and simply placing osseous grafting partials into the osteotomy site will ususally tighten this up.

We're still placing the occasional "press-fit" cylindrical (thread less) implants at th va. They integrate just fine. Even if the threads aren't all intimately touching native bone-who cares the clot will form, organize and integrate (cf. Allo bone/implant interface). Also, there were some studies on BPs and implant osseointegration, though I suspect the difference wasn't substantial enough to warrant the potential increased risk of jaw problems. Hopefully, btw, your spinning wasn't secondary to launching the implant into the sinus. I don't care what people say, putting the implant in the sinus cavity is not a good thing unless you can demonstrate the reestablishment of a sterile implant microenvironment which would happen under the sinus membrane and under the gingiva.

dear friends just wanted to inform that the implant is doing good and and was loaded 10 months ago. thank u for all ur valuble feedbacks and I personally feel that drug regime of Ostoefos [Fosamax, alendronate; a bisphosphonate] for three months did help in better osseointegration.