Replacing Failed Dental Implant: How Long Should I Wait?

Hi there! It would be very helpful if you could give a little more information, for example: What was the reason or etiology of the failure? If you can determine the reason for the failure, you can take the necessary steps to prevent it in the future or in your second try. You did not mention a graft. In cases where the bone height and width may suffer as a result of the failure, a bone graft is indicated to try to maintain the ridge. If this is the case, the sooner you can get a graft in the site, the sooner you can reenter for your second try. The two major contraindications for immediately placing another implant are infection and inability to get adequate fixture stabilization. My suggestion would be to wair 4 to 6 weeks for complete soft tissue closure, graft and reenter the site for implant placement 4 months after that. And go by the book, you don't want to do it a third time. Good Luck,

Dear colleaque I am completely agree with Dr.Boudet idea but i would like to mention that after 4 - 6 month it is good idea to have a preapical radiograph before reentry to the previous site.

It does depend the the source of loss of integration. If infection is present I would wait as above. If the implant is in poor quality bone and just never had the necessary bone to implant contact, would consider using a rougher surface implant that is slighty larger and waiting a longer time for the initial integration. For example I use titanium implants with a roughened surface. If they fail as above I would consider removing them and replacing them with an HA coated implant which to my knowledge is the roughest surface we have. If I wanted to do this replacement immediately, I would use a slightly larger diameter HA implant if possible. Since the controversy with HA still lingers, I would inform the patient as to the controversy and make sure they remain on a solid maintenance as you should be doing anyway. This has worked for me in the past, and all of the HA cylinders I have placed in this fashion are doing fine for up to 10 years.

Sir, studies taken place at the past have shown that the HA coated fixtures show a more speedy process of integration at the beginning of the insertion, but later on, this process shows a diminution in the dynamism of osseointegration until it is totally demarcated.By the way, it's been shown that due to the persistent compressive and/or off axial occlusal forces, the HA coating will go under breaking, flaking and cracking, which will have an intuitive negative effect on the durability of the integrating infra-structures.

The post recommending the use of an HA coated implant is not a bad recommendation. I would however recommend an HA screw design rather than a cylinder. Once HA crystallinity was increased and the application process was improved after the 1980's, the HA surface has proved to be very durable and dependable and it does induce osseointegration more quickly. HA is particularly advantageous in porous bone or where high initial stablity is absent or compromised. References made to studies showing flaking and cracking and separation are outdated. HA coated implants are presently still widely used although most of the market has moved to medium roughened surfaces because of the advancements in obtaining better primary stability and the use of an HA surface is therfore less relevant.

Hi! It is very simple.First findout the cause for failure of implant.Check patient health records.Check all parameters are within normal limits. As you have mentioned there are 'No signs of residual infection or abscess formation' you can plan to go for next diameter implant by performing osteotomy same day.You need not to wait until the bone repair is complete.There are no special precautions just stick on to basics of implantology.LET ME KNOW THE OUTCOME.

I relpaced one just yestersay. The inital root form did not integrate (was an immediate placement in #4 and a 3.75 x 11.5). I relpaced with a 5 x 11.5 and treated the inital osteotomy like an extraction socket (degranulate, decorticate etc and grafted with osteogen and prgf.

As your explanation regard to your case,it looks like out of systemic problem with the patient and would be something wrong with technical placement and poor osteotomy by the time of placing an implant.It's would be three possiblity of mistake with this case. First,over heat and necrotic bone remained in the hole, when you driling osteotomy. Second, Non-union: mean(NOT belonging to or connected with a trade union)by the time of placed implant in recipient site( non stabilization). third,contamination by touching the implant with instruments made of a dissimilar metal or by contact with cloth,soft tissue,or even surgical gloves may affect the dgree of osteointegration. Now answer to your first questions, you don't need to waite,waiting for what? no sine of infections or the site is not odonto-genic infected, so waiting time is equal to vertical bone loss.second question,NO contraindicated immediatly going to place new implant,but you have to go with this five step processes. 1-Gently clean up the site. 2-Would use osteotomy slightly LONGER and LARGER diameter as previous osteotomy. 3-Would use NEW implant slightly LONGER an LARGER diameter than previous implant( which implant failed). 4-Placing implant first with a MALLET(hand motor, gently tapped into place and finaly torque it with Instrument or Wrench tool(remember, you would NOT torque an implant in recipient site more than four to five torque per minute with no cooling and give it some tincture time to blood penetrate to implant surface first). 5- If implant is in static zoon, you maybe place a temporary crown, but out off contact with counterpart teeth.If implant is in posterior site,just closure an implant with soft tissue minmum for four mounts after re-cover and loaded,however, you will have adequate fixture stabilization. Dr.Vaziri-Iran Apr,22.2010