Dear Drs
I placed this 3.3 x 10mm implant a week ago and been having a bit of stress and anxiety about the position and future restoration. Extraction was done 3 months ago and bone was D4, primary stability was poor so I placed it a little deeper. When I was tightening it with a cover screw it was spinning a little so I reversed the implant and placed it deeper but even then did not get great primary stability. I believe it is 3mm subcrestal.
Mesio-distal positioning is also way off and could definitely be more towards distal and there will be a distal cantilever now. On top of it, it is a tad too deep I think. Patient is being reviewed tomorrow.
I am an inexperienced practitioner. What would the advice here be? Would anyone go in and reverse torque it 1.5mm when the patient is reviewed tomorrow to solve the deep placement? Would anyone remove implant, graft, let it heal, and re-enter in 3 months instead?
So,
you have a couple of issues which can be problematic, 1). It’s too deep. 2). At this angle, imagine where the impression coping will be if you were to let this implant stay where it is.
Because of the depth, it might actually get osseo-integration and in that case, you might get a lot of bone on top of the implant and in order to get to the implant with impression coping will require re-contouring the bone at 2nd stage.
Next time, you can go with a Wider implant for stability, (if primary stability is problematic) rather than deeper, provided of course that there is plenty of buccal bone for a wider implant.
I would consider removal, and you can possibly place a new implant with better angulation to fix all problems/issues/concerns that might occur after osseo-integration, at the same time. I would inform the patient that I see some issues with angulation which we are going to correct with a revision surgery. You have to correct the angle of your osteotomy, straight toward apex, resting on the the distal part of the osteotomy. You can decide if you want to place a wider implant with better angulation or just graft and let heal for 3 months.
Some points to consider critically when placing implants.
my $0.02
Are you sure it doesnt hit the sinus?
This case is restorable with some effort and compromise, but if you want better sleep at night consider to remove it and start from begining
explant
explain that if it were in your mouth, you would do the same.
Try tissue level nerxt time
Also discuss the food trap and open contact between 26 and 27
