Not Sure if Implant Osseointegrated or Not: Next Course of Action?

I installed a 3.75 x 11.5 Adin implant in #12 [Maxillary left first premolar; 24] 6 months following extraction of tooth and achieved good primary stability. Six months later the cover screw was exposed using laser and gingival former was placed. When the patient reported for super structure impression, the gingival former could not be removed with manual hex driver as it became very tight. Â Upon trying to remove the gingival former with the help of rachet, the implant had shown slight movement. Â So at that juncture I retorqued the implant back to original position, prescribed antibiotic and analgesics. What could have gone wrong and what is the next course of action?

(click images for larger photos)

![]Pre treatment IO Xray ( Six months following atraumatic extraction)](https://osseonews.nyc3.cdn.digitaloceanspaces.com/wp-content/uploads/2012/07/002-e1341579414947.jpg)Pre treatment IO Xray ( Six months following atraumatic extraction)
![]Six months after placement](https://osseonews.nyc3.cdn.digitaloceanspaces.com/wp-content/uploads/2012/07/003.jpg)Six months after placement
![]Immediately after retorquing into position](https://osseonews.nyc3.cdn.digitaloceanspaces.com/wp-content/uploads/2012/07/004.jpg)Immediately after retorquing into position

14 Comments on Not Sure if Implant Osseointegrated or Not: Next Course of Action?

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Dr. Akash Akinwar

7/6/2012

Dear Friend, After reading your case description i personally feel that Implant is failed to osseointegrate...If your implant shows mobility even after 6 months, it means it is failed...reasons could be different like contamination of implant fixture while placement, improper surgical procedure etc...I personally feel that there is no sense in waiting and expecting the implant to become firm (osseointegrate). Go ahead with removal and place another implant after 3 months. You can do bone grafting after implant removal to preserve the height. Best of luck..

peter fairbairn

7/7/2012

Agreed remember to currette the site extensively. Peter

Ning

7/7/2012

Another reson is torque in wrong direction and osseoingtegration is not perfect as well as bone quality is concerned. It is reasonable choice to torque it again if it is the reson mentioned above.

mengb

7/8/2012

Anyhow,I think at this condition it is necessary to remove the gingival former. Then the implant was at this condition for another six monthe. I think the osseointegration would form then because there is no manifest diseases according to the X ray

kais ismail

7/9/2012

Dear doctor I had the same problem and the gingival former was jammed with an upper 2nd premolar implant fixture so I removed the implant and held it with a needle holder and unscrewed the former from the fixture then I replaced the same implant to it's same position and then rescrewed the gingival former after lubricating it with an antibiotic ointment and left it for additional 3 months and it was successful .

CRS

7/10/2012

it did not osteointegrate

cagdas

7/10/2012

if an implant moves after 6months of placement. it means it is not ossteointegrated. just remove it. currettage the socket. you can either place a wider implant or greft and wait 4 months to place another. I would not take patient's 3 more months. hoping to ossteointegrate a fail implant.

Seth rosen

7/10/2012

I agree with the majority. Remove, curette, go up a size. I will run the original size bur in reverse at very low speed with a lot of irrigation after curette. Cleans the walls spectacularly. I also switch brands, usually to an ha coated implant (please don't hate me) as I learned from Niznick. Don't discount ha, i think it's coming back...

manish surve

7/11/2012

First of all there might have been fibro osseous integration .remove the implant .currete the site thoroughly ,either place a wider implant or graft the implant site with bone graft,wait for3 months and then proceed with implant placement.

dr tarek sameer

7/11/2012

hi there after examining the x ray i could tell that your patient has some periodontal issue from the level of bone at the site of canine and may be the type of bone at the extraction site was compromised and that,s why no osseteointegration so in my opinion currete the site and leave it for 3 months and reassess afterwards .

dean tanaka

7/12/2012

remove, currette, rinse with amox water, put in bigger implant. good luck!

Baker vinci

7/16/2012

If you are certain it moved at all, it's done! Remove it. Bv

Dr SenGupta

7/16/2012

Game over ...replace it

Richard Hughes, DDS, FAAI

7/17/2012

Looks like it was reversed torqued out. Dr Ismail, I too have done the same with success. It's a judgement call.