ZIMMER 4.7: long term prognosis?
This case is a follow to the case question I asked previously, Zimmer 4.7 in Posterior: is this normal?.
I attempted to install a 4.1mm diameter Zimmer implant in #19 site [mandibular left first molar; 36]. But, after preparing osteotomy site (using drilling sequence for the dense type of bone), I was unable achieve primary stability so I went to a 4.7mm (using one more drill for osteotomy socket enlargement) and achieved primary stability of 30Ncm. Healing abutment was placed at the day of surgery. After 3-months of uneventful healing, I took an impression and I inserted an implant crown [one-piece, UCLA type crown]. What do you think about the long term prognosis for this case? What could be a reason for the condition? Any suggestions?
June 2014
Healing abutment
October 2014, ready crown
Post-op OPG
10 Comments on ZIMMER 4.7: long term prognosis?
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CRS
10/12/2014
The implant and crown look fine. The dieback to the first thread is typical for this type of implant and should be monitored. However on the long term question the patient has significant bone loss due to periodontal disease and needs close monitoring and treatment. The periodontal pathogens can affect the implant also. This is a tough problem which needs to be addressed with the patient and unfortunately it is nothing new! Nice job on the placement.
ttmillerjr
10/14/2014
One thing to check for is gingiva around the implant/crown. A gingival graft generally helps if there isn't any. I did alot of Replace Selects that have no platform switch (just like yours) and I see this sometimes, uncommon with platform switch systems. I have found that many patients can maintain by using a WaterPik or Hydrofloss, sometimes without the graft.
omfseric
10/14/2014
Looks fine to me, and I use Zimmer exclusively for 20 years. (Other systems all work well, but the rep is the most important factor I believe) The bone will always 'shrink' to the roughened part. Any resoption stops at this level, unless perioimplantitus. You could get non-polished implant collars, or 1mm. Mine all look like this for the last 20 years, with <1% failure. I like the 4.7, diam. the wider, the more surface area, the more retention. Also, I think I would have used a 13mm implant here. Plenty of room. More retention. Just stress hygeine as you go forward. Get the thirds out, as they are only a harbor for bugs now. Have the pt get a water pik. Your major enemy is perio disease in this pt, (and most) . Address that frequently.
Timothy Hacker DDS FAAID
10/14/2014
I used Zimmer (Paragon) implants 15 years ago with good results. Platform switching will take care of the problem you are having. Make sure occlusion is correct--light contact and NO interferences. Monitor at every prophy.
Fabio Bernardello
10/15/2014
I used zimmer TSV for about 10 years with good results. Actually in tsv implants there is often this re-positioning of bone level at level of the first thread. In this case however the diameter at the neck is 4.7 (4.5 at the platform) and the crestal width of the ridge is 7.07 mm. This means that buccally and lingually in the coronal part of the site the Implant has no more than 1.10-1.20 mm and this is slightly lower to the recomended minimum thikness of the bone around the fixture (1.5-2 mm) This fact could explain this precocious marginal bone loss.
Anyway don't worry the Implant will work perfectly for a very long time. Your worse enemy in this pt is the periodontal disease, therefore check very often the situation.
rsdds
10/15/2014
Dr. Norman Cranin named this phenomenom Sauceration it usually happens when you place an implant adjacent to 2 natural teeth..
rsdds
10/15/2014
AAID exam question... bone remodeling to the first thread is normal
Carlos Boudet DDS
11/8/2014
A 4.7 wide Zimmer screwvent placed in 7 mm wide would normally leave about one mm of bone on facial and lingual of the implant, which may have compromised the blood supply to the thin crestal bone. If that is the case, the die-back is to be expected.
Generalizing that there is die-back typically for this implant is incorrect. Placing the implant in abundant bone without excessive trauma or overheating it can result in maintenance of the bone levels.
Once the bone level stabilizes to al level where it can be maintained by the blood supply( assuming the rough surface does not get contaminated), the levels should hold.
Good luck
Paul
5/6/2015
This looks like the Zimmer TSV with the micro threads. For whatever reason, I got bone loss with these. I switched to TSV-HA and have been much happier with recalls. Fwiw...
Reasondental.com
1/12/2021
This is very common on implants with micro threads and even more prevalent on implants with platform matched abutments. Using an implant design that incorporates platform switching and coarse threads up to platform will solve this 99% of the cases.
