Loose implant: what do you recommend?

Type of implant? What tooth is that at the distal, odd shape? I would remove middle implant and get primary stability by going deeper. However need to know why it did not osteointegrate. Was it transmucosal? Was the patient chewing on it? There is crestal bone loss on all three with those healing heads. Perhaps allowing the implants to osteointegrate protected and undisturbed is the way to go. I am not sure on the placement with relation to the crest looks like those tiny threads needed to be placed with bone contacting them but I don't know this system.

Yes, remove the dental implant and clean the socket. If you can confirm that there are no boney defects in the osteotomy site, extend your osteotomy apical another 3-4 mm but under prep the width of the osteotomy. You can then widen the osteotomy to size with a condensing osteotome. The dental implant will have plenty of stability. I would be ready to find a boney defect... most likely buccal when you inspect the socket after removing the dental implant. If you do, place a bone graft and membrane, wait 4 months and redo. You can make a transitional bridge on the adjacent implants in the meantime. Good luck

This seems ADIN implant .if it is...then quite popular n asian region specifically India. Most of Israil systems r doing good business in India. Anyways .. what was d torque of the second one at Implant placement?? I doubt it to b below 30n and if it was loose at d time of placement then we can't expect miracle at 2nd stage specifically when no graft was used at 1st stage. Sometimes fear of Sinus Perfo too may result in such situation. But what u r planing now is I think good and as CRS says going deeper and i would like to add PRF in grafting protocol around all d three wid d hope to cover exposed threads at d crest and Leave to osseointegrate (still better??) for nxt 3 months.. Good luc!

MIS I believe, nice implants have used them in the past. Take the implant out an evaluate the bony wall(reason for failure). Rep tells me these guys are sensitive towards insertion torque?. if all the walls present clean go more apically 4-5 mm and place another implant, if walls are not there or infection ,just graft.

Yes looks like C1 by MIS , liked the new EV launched by Van Doorn at Europerio here in London . But best remove and just let it heal for 3 months , I know I like to graft everything normally but here just leave it as possibly granulation tissue in situ . Patient will be happy to get the others restored for aesthetic reasons . Generally for this Implant type slightly deeper placement would have been preferable . Then after healing just do standard lateral window sinus augmentation and placement of a longer Implant to the correct level . Peter

I agree that from the initial placement time it is not firm.

Very strange situation....... the tooth which is supposedly a third molar, has the shape of a canine....long narrow root surrounded by excellent bone. From the xray film provided, it seems that none of the implants were buried deep enough...why? To speed up the process, I would extract the third molar, and place a longer implant into the tuberosity.... and remove the mobile implant during the same procedure. As a long time user of Medigma Technology Implants ( 23 years) developed and manufactured in Israel .... which then became ADIN Implant Systems, I can tell that the implants here are not from ADIN. By adding the distal implant into good quality bone, a temporary prosthesis can be made immediately to satisfy the patient. If you want to get good stability, take advantage of the implant's full dimensions and bury it to the crest of the bone. Gerald Rudick dds Montreal

It looks like #3 is not doing well either. I doubt it will integrate. Consider torque testing that implant too and redo both! if the bone is compromised, I suggest grafting and waiting

These implants seem to have a microthread at the head of the implant and a macrothread body - bit like astra (I know they aren't astra). The microthread part of all 3 implants is supracrestal esp #16, #15. #14 has a better mesial bone profile but still bone loss. Is that normal for this system or am I not reading the PA corrctley. I f you do have exposed microthreads then long term its going to be an issue. I think you may have a bigger problem than just a loose implant

I agree that implant in site of tooth #3 does not look good on your x-ray. Considering the fact that the fixtures could be deeper, I would suggest removing both implants in #3 and #4, grafting both sockets and returning in 4 months to place 2 new fixtures at the appropriate depth

If your planning on placing a new implant at the same visit that the mobile one is removed then you need to place a longer and wider implant to get good initial stability at placement. which based on the radiograph you have more then enough height and width to do this. My concern is the implant at 3 has significant crestal lose for an unloaded implant and I think you will have issues with this long term. also #5 also has some crestal loss or you didnt place the implants deep enough and have microthreads supracrestal when they should be in bone when placed

i understand 2nd premoler implant is mobile am i right ? check for the stability of other two implants , remove the mobile implant . if other two implants are well integrated give a temp 3 unit bridge . curette out the osteotomy site, look for any buccal bone defect . place implant graft prf and membrane and do submerged healing . after 4-6 months remove the temp bridge and make permanent restoration for three implants. or second option . if good stability of other implants. remove the loose one, give 3 unit permanent bridge . hope this helps regards. abs

If implants on sites of 3 and 5 have well osseointegrated, why don't you just make a bridge 3-5 instead of placing a new implant on the site 4. If everything is o.k. with the 2 implants, it should be enough to support a bridge. How about the opposite jaw? Teeth or denture? The problem may occur if patient is a bruxer, but then make a Michigan splint after FPD.

Are those tip threads suposed to be buried or not ?

(Rut) I asked similar question earlier about the micro-threaded area earlier but no reply. If the micro-threads are supposed to be subcrestal (and clearly they are not on any of the 3 implants) then why (as a prothodontist) would you consider restoring the implants? Something has gone wrong if one is already loose when unloaded and there is bone loss on the other 2 regardless of whether they are integrated. I assume some of the post here are happy that the implants are not mobile so "crack on" and restore but I would not say they are "integrated" if you have that level of crestal bone loss before you even start restoring. What will you tell your patient in 3 - 5 years when the necks of the implants are all supragingival? Are you going to blame the patient?

Clearly the concern's about the mini-threads being supra-crestal have been "voiced". Before placing another implant come up with some theories as to why this happened; maybe the mini-threads were never all the way in bone? Maybe no gingiva? etc... You know I don't get a good feeling about #3 implant when looking at the x-ray, I think this one may have an issue as well. Anyway, I would smooth away the supra-crestal threads of the implants that are staying--make them nice and smooth so plaque doesn't gather as easily. I bet you will lose 3 and 4. If so consider using the socket of the "third molar" to place a nice big stable implant. Since you've had complications I would bury any new implants (2 stage) you install.

i hope you understand the true meaning of my comment. I think you should redefine the criteria for "success" of implant surgery, and you will have less complications when you understand what you need to do to get there. If you put you thought on the middle loose implant, you will have more problems in the future. Other doctors made comments on what you need to do so i won't be repeating what already had been said. good luck.

I too have had s loose implant at the end of 3-4 months healing time. I remove it, clean the the area, and place a larger implant with good stability and allow proper healing without loading. This is one reason that I do not do imediate load.

No1.-remove mobile implant/implants. 2-mostly buccal defect will b there.dont think bone graft is needed.just go deeper and wider (as much as possible). 3-condition is before load..so dont compromise at all.otherwise after loading, again u have to go another work. 4-opposite jaw is also mater of concern. Best luck.