Implant success and failure all at the same time

Dr. Justin Moody discusses implant success or failure and how to prevent possible glitches from occurring.

Dr. Justin D. Moody reflects on a patient’s 2-year-old implant

Seems everyone has a specific criterion for what success and failure looks like.  Some judge it on the implant health, others on the soft tissue condition, and yet others on the prosthetic outcome. Truth is that it should be a view of all three of these criteria, and the overall status can be several outcomes.

I recently took care of a patient from one of my referral doctors. Having placed this implant over 2 years ago, he sent the patient my way as he was unable to remove the screw from the TiBase and was afraid to strip the hex. The first issue is that we had a debonded zirconia crown from a stock TiBase, and my first thought is always why.  What was the “why” here?  After 2 years, you would not expect this to happen. The answer is that the patient was eating some very sticky candy, so I will take this as the “why,” considering there were minimal cantilevers, and the position of the implant seemed to be good. Prosthetic failure for sure.

Figure 1 (left): BioHorizons Tapered Plus platform-switched implant in function for 2.5 years. Notice the bone levels and the growth all the way to the platform; Figure 2 (right): Crown has debonded, and the TiBase is left in place

Next, we removed the screw and the TiBase from the mouth. The doctor was having an issue as there was debris inside the hex not allowing the driver to fully seat.  Once removed, we cleaned the internal hex with chlorhexidine and placed a healing abutment to allow the soft tissue to be impression-ready for the referring dentist. So we have a soft tissue win here as the biotype is thick with no disease.

Figure 3: Soft tissue biotype is nearly ideal at 3 mm thick with an absence of any pathology or disease. Figure 4: BioHorizons wide healing abutment placed to restore the emergence of the soft tissue to allow for an ideal future impression

Finally, let us look at the bone levels on the PA. After 2 years, we can see that bone has grown up over the platform switch bevel of this BioHorizons® Tapered Plus implant.  This is also a win as the bone levels have actually improved from the time of placement.

Figure 5: The image shows that the crown has come apart from the TiBase, and the screw was removed without damage to the implant. All new components are needed from this point forward

What’s next? Can we possibly prevent this from reoccurring? Yes, one solution that was suggested was a new screw-retained crown, this time with a full titanium abutment and full contour zirconia bonded to it.

Perhaps we should view or categorize our success and/or failures differently going forward to more accurately represent what is going on.

Regarding implant success or failure, Dr. Justin Moody says that implant design is key to achieving lasting goals. Read more about how this technology continues to evolve here: https://implantpracticeus.com/when-implant-design-matters/

Justin D. Moody, DDS, DABOI, DICOI, is a Diplomate in the American Board of Oral Implantology, Diplomate in the International Congress of Oral Implantologists, Honored Fellow, Fellow, and Associate Fellow in the American Academy of Implant Dentistry, and Adjunct Faculty at the University of Nebraska Medical Center. He is an internationally known speaker, founder of the New Horizon Dental Center (nonprofit clinic), and Director of Implant Education for Implant Pathway. You can reach him at justin@justinmoodydds.com.

 

Disclosure: Dr. Moody is a paid consultant for BioHorizons®.

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