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Loose Dental Implant
Dr. Shephard asks:
My patient was missing #7-10. I had my oral surgeon place 2 dental implants
in the
positions of the upper lateral incisors.
I asked him to check the dental implants to make sure they were fully integrated so I could go ahead and make the bridge. He dismissed the patient after he did the uncovery of the dental implants, saying everything was fine. However, when I went to make the impression, tightening down the impression coping screw caused some pain. I also noticed the dental implant was slightly loose. What should I do next?
May 15, 2006 in Treatment Planning & Complications | Permalink
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Comments
if dental implant is loose(it has to be checked & confirmed ), you should send the case to the original o.surgeon to deal with it,possible take it out ,bone graft the cite,then replace it with another implant.impression post has to be checked if it fit proper, x ray should be taken to check the fit befor taking the impression. good luck DR.ALI
Posted by: DR.M.ALI DDS.MS. | May 15, 2006 9:16:02 PM
Granulation tissue has grown around the implant preventing integration (some callll it a "spinner")it has to be removed and an implant the next width up placed....good luck
Posted by: p fairbairn | May 16, 2006 12:14:50 AM
I am sorry to say that implant is lost... get it removed and if the bone height is ok place the next size up one, if not, graft, wait and place another one.
good luck
Posted by: Alejandro Berg | May 16, 2006 1:58:56 PM
Refer the patient back to the oral surgeon. Unfortunately that implant may be lost. But there is nothing you can do with a loose implant
Posted by: Georgie Garcia | May 16, 2006 2:32:17 PM
If indeed your abutment was seated properly and not impinging on tissue, this implant didn't integrate properly, it has to go. You have to confirm what's going on for yourself. Take the pa see that the abutment is fully seated. If it is and you have movement forget it. Theres no such thing as it'll tighten up . The sooner it's out the better. It could be removed and if there's enough bone ,replaced with a slightly wider or longer implant at the same time
Good Luck.
Posted by: Dr. R Mosery | May 16, 2006 2:58:37 PM
Basically I would stick to some of the comments I read, but not removing the implant immediately. Always be in contact with the surgeon who made the operation and both of you will find a solution.
Usually when and if we loose an implant, we loose it during the first two weeks from the insertion and most of the times if the patient complaints for continuous pain and usually this pain does not go away then I believe that this implant must go. But we have seen plenty of cases that the implant was not fully osteointegrated when placing the gingival former and of course the patient has some pain. I would leave the implant to stay for at least one or two months so it will osteointegrate in the event that the pain would not continue.
All the best!
Posted by: Marinos | May 16, 2006 11:01:08 PM
I find it amazing that with such limited information dentists are willing to immediately suggest removing the implant and even further suggesting placing a wider diameter implant in this narrow area of the esthetic zone.
Please consider discussing with the oral surgeon the pain you noted when tightening the impression coping screw and have him/her evaluate the "slight" movement you observed (did he or she observe this at stage 2), was there bone grafting, was there adequate time allowed for integration, what were the torque values at placement and uncovering, ISQ values if Ostell utilized?
In the esthetic zone always be wary of increasing implant diameter size. If the correct diameter was chosen initially, increasing the diameter may cause loss of labial bone and an ensuing esthetic disaster. If in fact this implant is ultimately a spinner, either remove and graft or consider additional implant length for initial stability and graft the labial defect. If it is not lost, it has been an excellent learning and communicating experience for your implant team.
Posted by: Dr. Lytle | May 17, 2006 4:18:07 AM
Send it back to the OS. If you accept the case, it is yours. The last one to touch the the case is IT. Next, change OS or get a periodontist--they are more of a team player.
Posted by: | May 17, 2006 5:33:02 AM
I can't believe someone would post a message and state that perodontists are more of a team player. As an oral surgeon, I strive to stay in step with all my implant cases to make sure all goes well. This is not a matter of OS vs. periodontists being team players. We are all dentists and we are in it for the best interest of the patients.
As for this case, send it back to the OS to make his own assessment.
Posted by: | May 17, 2006 7:50:38 AM
I doesn't matter what the speciality is it is always the person that counts
Posted by: dr. kimsey | May 17, 2006 1:10:00 PM
I had something similar happen to me. i was using ankylos implants, and at second stage surgery, I placed the healing abutments and everything seemed solid. the tissue was hardly disturbed at all, so i decided to take impressions using open tray copings. i threaded off the "sulcus formers" and placed the copings, took the impression, unscrewed the coping screws, but 2 of them had "cold welded" to the implants. i removed the impression, but could not get off the copings. 2 implants came out in my attempt-totally my fault, and stressful to say the least. i "pressed" the implants back to place and covered them up. had the patient return to put in 2 new implants in different location and left the 2 "spinners" in for 5 more months, at which time the 2 new ones had integrated, but one of the previous "spinners" failed to re-integrate and one intergrated. good luck
Posted by: scott hamblin dds | May 17, 2006 4:02:24 PM
Drs. MArinos and Lytle seem to have the right idea...as do some others. If you do not have constructive information...keep it to yourself...Implants of any kind take experience and expertise...the more you do the more you will deal with complex situations...people like Dr. Shepherd come here for HELP, doctors, lets try to remember who we are and what we do...It is the patient that matters! Sorry for the lecture...just some things i have seen lately make this site less of what it is supposed to be.
Posted by: | May 18, 2006 5:54:17 AM
I agree that more information is needed. How much time has been allowed for integration to occur? Is the pain caused by the impingement of the impression post(s) on the soft tissue? Is there pain and/or mobility on both implants? How about the radiographic picture? If you ask me for my gut feeling, you will probably lose the implant. No integration....no restoration. Take it out.
Posted by: David C. Garrison, DMD | May 20, 2006 4:22:30 PM
I totally agree with Dr. Lytle. There is not nearly enough information given here to make any recommendation. I read a bunch of CYA answers which disturb me. The oral surgeon and restorative dentist are supposed to be a team. Where's the team play? If you referred the patient to the oral surgeon, you look as bad as he does if things don't go right. Work together and you'll achieve the desired outcome even if the road is sometimes bumpy.
Posted by: Joel M. Moskowitz, DMD | Jun 12, 2006 2:16:55 PM
Dear Doctors: After one year, I am suffering from severe pain 24/7 and numbness in upper maxillary area where two dental implants were surgically placed/two phase surgery. Can you please advise as to what might be causing this pain. I have an appointment with a neurologist for help. Please advise as no one seems to want to explore causes (i.e. dentists or oral surgeons) or potential surgical removal. Thank you for your expert advise.
Posted by: | Jun 26, 2006 4:49:36 PM
I had two implants placed in my two upper teeth 10 years ago. I have never had a problem beforre - but suddenly and unprovoked, they are loose. Any scenario where they could be saved?
Thanks.
Posted by: | Sep 24, 2007 3:56:25 PM
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