I’ve had 4 recent implant failures out of about a batch of about 20. My confidence in myself and my implantology is getting shot.
I fear for my reputation as a surgeon.
First patient was a smoker- 2 implants failed. I used 2 ROOTT implants with non-submerged healing. Good primary stability but I think I should have submerged the implants. The patients smoking habit could have contributed.
Second patient was probably not my fault. The restoring dentist did the final crown at 1 month. I thought that he will do a temp first, but he went to final and the whole implant came out.
Patient 3 is a positioning and technique error. It looks like I have to remove the implant- GBR and reassess in 4 months.
I’m a newly qualified Perio but I should be doing better. I hate failures. I obsess about what I could have done better. My colleagues will probably start talking and my referrals may dry up. I’m really worried about my reputation.
I feel like I’m hurting patients and not getting the results that they deserve.
Next time include pre op/post op PA. sometimes you just have a string of bad luck.
smokers have a >20% of implant failure. whereas nonsmokers have <5%. that’s a huge difference. I often tell smokers, during tobacco use, if implants failed, replacement will be extra charge. no one likes failures, if patient is noncompliant, pt has to take responsibility for failures also.
early loading is always a debate. You didn’t specify which tooth position. i would never restore a posterior implant at 1 month. i’ll place a provisional implant crown for anterior teeth even then the tooth would be out of occlusion to avoid occlusal trauma to freshly placed implants.
You didn’t specify what iatrogenic positional and technique error. Also you didn’t specify the size of alveolar ridge.
I noticed i get failure when i try to push the boundaries of implant placement in subpar alveolar ridge. without leaving 2mm around of bone around the implant. the more bone the better. Taking risks during implant placement will result in more failures. I dont think being new or old perio has anything to do w/ implant failures. Drs all hate failures. but that is part of implantology. No one’s records are perfect. unless you only placed 10 implants total. I think you should present the case better so we can try to understand how you suffered these implant failures.
good luck
I am so sorry to hear this and I unfortunately have felt your pain. Over the course of my career as a periodontist I have experiment with multiple implant systems (Nobel Biocare, 3i, Straumann, Zimmer, BioHorizons, Implant Direct, Blue Sky Bio) and while they all work I have personally had problems and higher failure rates with a couple of these products. As a periodontist I was always concerned about placing a product that my referrals wanted to restore and unfortunately the driving force for most of them was $$ which led to me placing some discount junk over the years. After a cluster of failures a while back I went back to the basics and purged my shelves of all the junk leaving only ZimVie/Zimmer TSVM and Straumann TL as my fixtures that I will place and I did the same with my bone grafts and membranes. I would suggest going back and finding the products and materials that have worked for you and stick with them regardless of the additional cost because in “most” cases we really do get what we pay for. Obviously what works for one person might be different for another person so figure out what works for you and roll with it. Since I purged my shelves of all of the product that I lacked confidence in my problems have essentially disappeared. At the end of the day we have to have confidence in what we are doing and what we are placing. I have confidence in ZimVie/Zimmer TSVM and Straumann TL because both of these products have worked well for me and have been successfully use by millions while neither of these products have been modified from their original designs since 1998. While Zimmer TSVM has been an extremely successful product for me the newer Zimmer TSX failed miserably in my hands and nearly drove me out of implant dentistry all together so clearly different things work for different people… If you are a fairly recent perio grad then you are probably trained to use higher quality and more costly materials than what you are experimenting with in the competitive market and while I completely understand the pressure to do this I think you would be happier if you went back to what you were trained on. Just a suggestion from an old gum gardener who has been through the growing pains.
I do almost all guided surgery, sometimes only a pilot guide. If you plan your cases with a tech it does help and still gives you control over final placement plan. Make sure you are using good implants, and I can say that the Z3D kit from Zimvie for guided cases is great. If you do them guided there are less surprises, but you still need to have more course work to become a practitioner that can adapt to those surprises. Make sure your restorative dentists are not in over their head and discuss cases thoroughly. We use a tracking sheet that has everything they need about the implant case including a section that says how long the healing time should be BEFORE restorative. Also make sure they don’t try to use similar or OTHER equipment like the wrong drivers for internal screws etc… Hope that helps. Here’s what my tracking sheet looks like.
I am an old TSV user and as such have been in the habit of under sizing my osteotomy in the maxilla/soft bone for many years. According to ZimVie this is a not unusual as a lot of us old timers were taught to undersize for the purpose of increased stability but apparently this technique does not apply to the TSX. All of my failures occurred in the maxilla and all of them occurred 6-12 months after the delivery of the restoration which would imply some sort of slow necrosis rather than a good old fashioned failure to integrate. At any rate I discarded all of my TSX stock and have decided that for the remainder of my career I will stick with the tried and true originals, TSV and Straumann TL, since I know they work in my hands and have for 20 years now… I will retire from dentistry before I will ever use another implant product and that hard truth came with a lot of expensive growing pains. I assume if you follow the “new” strict placement protocol then TSX is a fine product but not in my hands… I also drive a Ford F150 and will until I die because while Chevy no doubt makes a good truck I have had transmission troubles with both of the ones that I have owned so my solution has been to stick with what is comfortable and works… for me…
