Post-implant Complications

A 58-year-old man has two types of implant complications: periimplantitis at #4 (in spite of 2 bone graft surgeries, Fig.1) and abutment loosening at #14 and repeatedly 19 (probably due to bruxism, Fig.2,3). 

For the implant #4 (4.5x14 mm), there are 2 options: exposed thread or implant removal.  Either way, make an ample incision.   Prepare long diamond burs.   Soak several pieces of gauze in 1:1000 Epinephrine.  The implant will be removed using 5/6 mm trephine bur or surgical handpiece, followed by immediate placement of a bone-level implant with the longest abutment cuff (Fig.1: 6 mm (pink)).  Insert PRF (purple line, 4-5 tubes of blood) and allograft (red circles) prior to implantation.  The implant/crown ratio is poor, place a long healing abutment or cemented abutment with the shortest abutment height (4 mm vs. 7 mm of the final one (Fig.1 blue, 6-8 months of healing)).  If the site is unfavorable for implantation, a 3-unit bridge will be fabricated. 

To overcome bruxism, implants will be placed at the 2nd molar sites (total 4).  Since the implant at #19 was placed distal, the crowns at #18 and 19 will be splinted.  The unipost at #14 is 6 mm, 10º cemented with Ketac (implant 8x14 mm).  To increase retention, use bonding and place 1 or 2 heavy retention grooves or use a straight abutment.  If the existing abutment cannot be removed, enlarge the retention groove and bury a piece of wire in the groove with bonding.  The last resort will be splinting with #15.

Return to Upper Bicuspid Immediate Implant, IBS

Xin Wei, DDS, PhD, MS 1st edition 04/21/2017, last revision 01/19/2018