Suggestions for Best Protocol for a NobelReplace CC Implant?

About a week ago I placed a 4.3x10mm NobelReplace CC implant utilizing surgical guided technique in the area #19 on an otherwise healthy, nonsmoking female patient. Upon placement of this implant final insertion torque was measured about 10-15Ncm. Since a surgical guided technique was utilized, the final drill of the surgical protocol had to be taken to depth with no additional drills to overprepare the site, and since tissue punch was part of drilling protocol, a healing abutment was used. Please see post-op x-ray as well as HU index that shows bone quality prior to insertion. I was wondering if you could comment on how important is it to remove the healing abutment only to insert a cover screw and cover the area either with a membrane or soft tissue graft in order to avoid pressure from food or tongue because of the low insertion torque. Please note that abutment is almost at the tissue height and receives no pressure from any prosthesis. Thank you and your help in this matter, it is as always greatly appreciated.

7 Comments on Suggestions for Best Protocol for a NobelReplace CC Implant?

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Timothy C Carter

10/9/2018

Just remember that Straumann started as a tissue level implant with a 1.8-2.8 collar and has tremendous documented success. I say this because I know a lot of these have been inserted with low torque and have done fine. IMHO there is way too much emphasis placed on insertion torque/primary stability as it might relate to implant survival. I certainly would't remove the healing abutment within the first 6 weeks as stability will initially dip and then begin to rise again.

Dr. Gerald Rudick

10/9/2018

I think you did a terrific job in placing the implant. If there are no forces that will act on this implant while it is in the mode of becoming ossointegrated, leave it as it is. Just instruct the patient to keep the area clean, and to notify you if during the healing period if they find the healing abutment has worked itself loose.....by doing the procedure as you did it, a second uncovering surgery will not be necessary.

Mick

10/9/2018

Seems like it would be a bit risky to go unscrewing and replacing and then doing surgical procedure at this point. Just let it sit.

Howard Abrahams

10/9/2018

Don't touch it. You may want to wait longer (6 months) before going back only because of low insertion torque. If it fails, it fails and it will basically exfoliate on its own. Xray looks good. Just tell patient to eat on the other side if you're concerned. And say a prayer. Under his eye.

mark barr

10/9/2018

leave it be at this point; couple of questions though (just to stimulate thought) . when was the torque level measured? (before or after healing abutment places?) .what torque level is best covered? . what torque level is â€œsafeâ€ to put a healing abutment or an immediate load on? .how dense was the bone (touchy-feels) while prepping the osteotomy site? Paying attention to this allows the clinician to determine if they complete the entire drill set protocol. Sometimes the last drill is used 1/2 to 1/3 to depth in softer bone... . just because â€œitâ€™s guidedâ€ does not mean we can pay less attention. Thank you

Steve Hurst

10/10/2018

Leave it alone for 6 months and see what happens. Thatâ€™s a nice placement. Iâ€™m associated with a live patient course that places over 1500 Nobel CC implants a year ( Active, Replace and Parallel). Our protocol calls for a healing abutment at 35Ncm and 250 HU or more. Anything less and weâ€™ll see the patient back for a stage two surgery. We like a minimum initial stability of 15+ Ncm. Anything less and we socket graft. All our implants are placed free hand with full thickness flaps so we have the option of not placing a healing abutment. We see 150 doctors a year, most are new to implant dentistry and our implant success rate is 97-98%.

yosef k

10/10/2018

Beautiful placement . Not sure why you overprepared site .