Couldn't torque the implant all the way in flush with the bone?

I had this case today where the bone was very very dense. Was using a Nobel kit and even though I was drilling double the recommended speed, it took me a good amount of time to get to the recommended length. This was in a tricky area close to the ID nerve and patient started feeling sensation and "ache" as I was getting closer to the 2mm zone from the ID canal. Anyways, I was placing an RP Nobel 8mm but couldn't get the implant flush with the bone, took the implant out went to the WP drill and placed the implant again, still couldn't get it flush on the buccal side. The radiograph looks very bad and to be honest I couldn't do anything else as I ran out of options. Can you please let me know what I did wrong? Is this going to be a major issue in the future and if I can rectify it? Thanks a lot in advance.

AG92 comments:

You may have hit the dense lingual cortical and maybe there is a lingual concavity. Please post a cbct slide of the area. Implant may also be too wide and taper for this area

Robert comments:

Did you take a cbct before treatment planning this?

Jfaziodmd comments:

Does your kit have dense bone drills or screw tap for aid in denser bone ?..... probably engaged lingual cortical plate as well. Be careful with Tri- lobe replace implants ( if that’s you’re system ), they will fracture more easily at high torque due to thin implant wall at platform

I’ve had this issuebeforw comments:

Ahh. The replace system. This is a pretty common issue. The drills are a touch longer, the the tip is much narrower than the implant. So the implant doesn’t go all the way down in dense bone easily. If going to a dense bone drill doesn’t help, take a lindermann drill, put it at apex and bore it out without going apically. Good luck!!

Juliette Dominicus comments:

YESSSS. I could not drill up to 10mm because I was gonna hit the ID canal, so I was left with no option, either drill to 10mm and hit the nerve, or leave the implant slightly unseated.

I will buy a linderman drill but I learnt my lesson this is the LAST Nobel implant I will ever place. I purchased a Straumann kit immediately.

I have had a few issues with Nobel Replace and their customer support is pretty rubbish.

In your experience, what are the likely issues that I will face in the future please?

Tim comments:

This is a variation of normal with the Nobel Replace. Too much taper and no cutting threads. It’s a bad system and is fortunately fading away.

Juliette Dominicus comments:

I am afraid I wish I had seen your comment prior to ever knowing about replace, I would have never chosen it.

Víctor comments:


Juliette Dominicus comments:

Hi Guys,

thank you so much for your comments.
I could have but based on my CBCT planning I was very close to the ID canal and the patient started to report sensation as I was getting closer within the 2mm zone, so I did not want to push it.

Yes I did. I had 10mm of height and 8mm of width (I did the GBR myself 6 months ago)

This is the Replace Nobel kit, probably one of the worst implant systems in the world. I did not have a dense bone tool but I went up a size but still could not seat it all the way down.