What Could Have Caused this Implant Failure?

You do not have to see any of the symptoms you just mentioned on a failing implant. It simply failed. I could write you a chapter on the causes of an implant failure, from subclinical infection to contamination to overheating. I hope you grafted the osteotomy once you removed it. Then go back in three months w a new implant.

your implant did not fail you should have loosend the cover screw and then screw the implant back in its place and go on with your procedures.i had the same accident one year ago and done so every thing is fine so far good luck dr

I disagree with Dr. Naser. Once an implant fails you will have fibrous encapsulation in the osteotomy and the implant is pretty much contaminated at that point. The implant had to be removed.

I agree with Dr. B. fibrous encapsulation is the usual cause. I dont know when you took this PA. Good new is if bone volume allow you go back at six month and can place an implant. However other 3 should be able to hold a bridge for you so no need to worry much.

Dear Colleague The implant did not fail. Because you are dealing with a 70 year old, the healing, regenerative, osseointegrative, bone mineralization potentials may be dramatically diminished compared to a much younger individual. My guess is that if the cover screw was difficult to torque out, perhaps one option would have been to leave this particular implant buried for another 4-6 months before trying again. Of course, the assumption I am making is that there are no other uncontrolled health variables in the equation. Best Wishes

Just to make an additional comment, An additional assumption ... proper pre-op diagnostic & treatment planning and surgical protocols were followed ... however, sometimes, and fortunately rarely, these things do happen to the best surgeons...and more importantly, how do we as responsable and conscientious care providers, troubleshoot the issue. God Bless

the patient is 70 year old. so the REGENERATIVE N OSSEOINTEGRATION potential is quite low in his case. more over the implant placement was correct but as u overwrenched the cap so thre is significant lossening n remember once contaminated, encapsulation stops u from replacing again. u have to wait clear 3 months do osteo again n placve the implant, all will b well. of course do cone beam twice, now n after 2 months to evaluate the cortical density pof the bone. use guide track , adds ease n smothness to ur working in tissue exravasated site like insisor n lower foramen area

I had the same issue! Reimplanted, with 2 stage surgery. Buried wait for osseointegration, with elonged healing time it succeded. Parodontal disease patients and smoker can produce this also...This happened with me....

I agree with Dr Marcone. Probably this bone was type IV. Also we have the problem of the patient 's age. So I think the best is wait more time to do the second stage surgery .

Do you have an x-ray of the fixtures that was taken at the end of the placement appointment? SG

It simply failed. Once you do a few , statistically even if you have 95% succeed one out of 20 of your Implants will fail. Don't worry! If the the lateral walls and the apex are intact just place a longer/larger implant. MAKE SURE ALL THE SOFT TISSUE IS REMOVED and place your new implant. If the bone is too compromised graft the area. You treat it like an extraction. Your X-ray shows that you lost some crestal bone on#5 as well. Was this a immediate extract/implant? Maybe placing the implants a little deeper next time and account for crestal bone loss especially with thin plates.

My dear colleagues, the important issue that needs to be discussed here is whether we have safe diagnostic tools to know when an implant is osseointagrated and more importantlly what is the quality of osseointergration. I know what to do when i have a radiolucent,mobile implant,but in a case like this maybe the force i applied to remove the cover screw damaged the bone -implant contact.So we have to know how well osseointergrated is an implant before we put it to function. ps.this is an x-ray taken at second stage.

Dear Dr. Nick; first of all ,you did the right implantation,because in elderly patients w/ impairments of healing process ,the best is to place more implants , than needed to be safe. just in case of loosing one of them , still the rest can give you a good fixed pristhesis w/o any problem. to find out why this one failed, there are many issues, such as soft bone,over drilling, over heat, low primary stability, newly extacted site, etc..... any way practically, you have no problem in loading them as I said , GIVE THE PT. A FIXED BRIDGE.& no need to replace the missing implant. WISH YOU SUCCESS.

The only reliable test is when you torch it. Leaving it longer etc won't make a difference. Once it has failed to integrate it won't, no matter how much longer you keep it in there.

FURTHERMORE, I think if you gave more time for osseointegration to this particular old pt. would be the best, probably no failure.

Am I missing something?? The x-ray shows at least 50% bone resorption on all 3 implants. Are we to expect this to appreciably change if you give it a few more months?? I don't think so. I personally don't think this is a good situation to ask a patient to accept, even if he is 70 years old. This patient had the expectation that he would have implants that were fully covered by bone. This patient deserves a better result which I think should be offered to him.

I would really like to see the x-ray that was taken after all 3 fixtures were placed and the patient was dismissed...without this, we have nothing to compare to the x-ray that is presented. I am very curious to see what the bone looked like immediately post implant placement. Thank you.

The best thing to do is: 1. Do not make a big deal about it to the patient. 2. Redril the oteotomy slightly deeper. Torque in another implant and place a cover screw. 3. Tell the patient tht he will need more time for healing. It takes minutes to do adn save the day. You already have the osteotomy. All you are doing is freshening up teh site adn extending the length slightly to get better fixation. Simple!

What could have caused this failure? Lack of integration caused by chosing the wrong brand of implant and/or perhaps a bony defect at buccal side of the implant that has caused a longitudinal exposure of the threads out of thr bone, but under the mucosa.Sans Doute.

When he felt pain rather than increasing torque to remove the screw, you should have stopped! Waited 3 months, then tried again. I bet the parroting site was clean, with no soft tissue evident? Treat it like a spinner if you have mobility, time would have healed it, assuming it had a nice high pitch ping with a LATERAL tap with a mirror handel.

Was there any soft tissue found in the osteotomy after removal? I'm willing to bet the implant was somehow loaded under the tissue from a hard lined denture or something, especially if you have the implants sticking up as high as the radiograph shows.

There was no soft tissue found in the osteotomy after implant removal.What you see in this x-ray is the implants with their healing abutments attached after the uncovery phase,except 13 where the cover screw was stuck.During the healing phase the implants remained covered with tissue.The patient was provided with a provisional denture.I think that was a very conservative approach in the age of immediate implantation and immediate function!

Dear Dr I thing your hand pressure was more during tightening cover screw in addition you must use some antibiotic ointment when you are tighteninig cover screw for prevention of coldweld of two metalic part .Time is a important factor for second part of surgery.Sharp pain feel by your patient was exessive load to seperate stability and integration.I had such case I try to open cover screw it was tight , implant was in posterior manibular 6 .slowley I tray to open screw I put my finger in both side of tooth I open the screw the implant is in good healty position now. I learn to never tighten cover screw.Some implant system have tendecy to coldweld .what was your implant system. If patient is old we must know the way to treath them .We must mannage the condition.If blood circulation is less we must use the way to compensate it.Each part of the jaw require special treatment.

Type 4 bone, low quality and low quantity. Integration failed. That's it! Don't over think it. Remove the implant if it's mobile and/or symptomatic.

I also think a coldweld might be the cause. Of course during the attempt to unscrew the coldwelded cover screw, there must have been much stress on the surrounding bone, thus the pain experienced by the patient. Dr Fereshteh Tarashi might be on to something. But, leaving the "implant not integrated" theory aside, what is the proper way to deal with a coldweld of the cover screw? I think it is an interesting topic for discussion. How do other doctors deal with this complication?

Dr Ares,I think you are close to what I believe has happened with that case.My only question is this:how did i manage to unscrew this implant through the coldweld cover screw, when the force that I exert with my hand is far less than the force the implant needs to be removed when it is totally ossseointergrated?

Don't screw implant back if implant came off. Thats not going to do anything. Unless you want to restore and spent lots of money on restoration and then patient will come back with pain and resorbtion and you will remove restoration, implant and loose money of it. The implant is failed and thats period. Graft the site, place implant in 2-3 month later.

What is the maximum amount of force that can be applied to an osseoitegrated implant without fracturing the bone to implant interface? I will investigate, but for sure it is way less in the maxillary bone, it is far more flexible...

This case probably needed more time (old patient). Also do not overtighten the healing screws. You could of inspected the osteotomt and simply replace the inplant and first add a little Osteogen to the osteotomy.