Mobility in implant: Treatment Plan?
I have a new patient who presents with 3 implants in the mandibular anterior region retaining a mandibular overdenture. #31 implant [mandibular left central incisor site] has increased mobility and is preventing her from chewing comfortably. What treatment plan would you recommend?
11 Comments on Mobility in implant: Treatment Plan?
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Richard Hughes, DDS, FAAI
12/20/2015
Remove the mobile implant. Degranulate the osteotomy site and graft. You can place one, perhaps two implants to the left and fabricate an immediate bar with overdenture, once the proper steps have been made.
Carlos Garcia DMD
12/21/2015
Remove the implant and degranulate the site.. Place two implants in the left side. With four implants the prostheses will be more stable.
ST
12/22/2015
As stated previously but how about the #31 fixture, is that also presenting radiolucency or is it just poor imaging?
Alejandro Berg
12/22/2015
Remove implant, clean the area. place 2 implants on the left. if there is a chance prepare a hadder or dolder bar and a new overdenture.
rut
12/22/2015
I agree with above remove , place 2 implants on the left
Tuss
12/23/2015
I would consider removing all the implants, allow sites to heal (graft if needed) then re-plan and place ideally spaced implants especially if you are considering a bar. Not sure how long those implants have been in plus you have 1 failed, possibly 1 or 2 more may be failing so why take on such a burden - clear them out and start again so you can sleep at night
Arpit
12/23/2015
Thank you so much for your valuable suggestions
Is it possible to give a prosthesis with two sound implants and removing the one with mobility
Tuss
12/23/2015
I would avoid trying to use the two lower right implants only as they look to close together to make a bar so Locators or ball abutments only option, plus if relying on just 2 implants then want them to be equally spaced - usually at #32 and #42 (LR2 and LL2).
If you were not the person who placed the implants initially then I would avoid trying to play hero in this case. If you want to keep the two implants then you need more implants in the lower left quad to balance things out - don't work the case with just the 2 implants.
joshua keren
12/26/2015
I "hate" dentures of all kinds and this case looks like a perfect case for ' All On 4' Obviously C.T. is a must.
Gianmarco
12/28/2015
I agree with Joshua.
Jaime Ramos
1/5/2016
I don't agree that fixed prosthesis is the answer to all cases especially the elderly , 2 implants & locators correctly placed has the advantage of the elderly maintaining them clean and for the clinician to observe clinically the presence of inflammation etc without having to untorque screws etc .
On all 4 have complications eg fracture of the metal distally due to fatigue , screws & OH and costs not to mention clinical time and complications . Patients now live to their 80's + and it such a pleasure to ask the patient to remove their overdenture , observe and change the nylon caps ! Obviously chewing capacity is less but complications are very likely to appear over a 20 year period and then what !
