Immediate Implant Loosening

This complication most often occurs in the premolars (1,2), where the socket is oval, while the implant is rounded.  The implant has to be engaged to the lateral walls of the socket for primary stability.  It has to be as long as possible.  If the implant has reached its maximal length without any sign of infection, simply watch (1).  Sometimes the loosening implants look extruding.  After local anesthesia, torque for a few turns until the implants regain stability (2).  Placement of D implants may be able to solve the socket/implant shape discrepancy.  To reduce tapping associated with D implant placement, drills can be used for initial osteotomy.

If an immediate provisional is fabricated, there should be occlusal clearance with post-op instruction of not chewing on the affected side.  It appears that implant loosening is exclusive with male patients, with bruxism, multiple missing teeth (1), next to infection or loss of the buccal plate/with infection (2).

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Xin Wei, DDS, PhD, MS 1st edition 12/20/2015, last revision 12/20/2015