The top x-ray is from the surgical day and the bottom one is 1 month later. Seemed to be a routine procedure with light torque (5-10 N/cm). Any comments on cause of bone loss? Is this a do over? Thanks for any comments.
Dan
I would put a cover screw on the implant, and graft around it rather than redoing.
If the fixture was inserted at 5-10Ncm then it was clearly placed in some soft bone, nothing wrong with that but clearly pretty soft and spongy. Because of this it is reasonable to assume that the coronal portion of the bone is also soft and possibly poorly mineralized. The two images are taken at quite different angles which is likely having an impact on how we interpret the results. Look closely at the bottom image and you can see what appears to be a free floating radiopacity on the mesial and the void on the distal looks like it has had a similar fragment exfoliate but upon closer look the distal shows some radiographic signs of remineralization within the void. I think you are witnessing the natural remodeling process of soft bone and this is one of the many reason why I do not routinely take images of fixtures except at placement and again at 3 months… unless the patient give me a reason to expose more.
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Thats good insight and a good tip @scotty
I just placed this fixture about 2 hours ago and it went in at 10-20Ncm which means fairly soft bone. I visualized it during the procedure and the threads are completely in bone despite what the x-ray might say. The tooth was extracted about 3-4 months ago and the site was healthy but not yet fully mineralized and thus a potential radiographic discrepancy similar to what you show. I would expect this to have some remodeling/turnover and will not take another image for 3 months unless I have a really good reason to do otherwise.
Next time if you fell No or thin cortical bone and soft bone type, better you follow the two stage protocol. I guess you could avoid this unwanted situation.