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This is new for us and perhaps for you as well. We are trying to get a frequently updated, interactive forum where I can post bits of my implant experiences, as well as respond to your contributions. This area of the site will be restricted to dental professionals so we can have a secure environment within which we may interact. Please get your friends to register on our site and join in. I promise it will stay interesting! We’ll also post some case pictorials and anything else I find too fascinating to keep to myself.

Case Blogs

1/20/2014
Implant failures: My reply to comment on AAP site about some failures with 2 different systems that cannot be explained:

After working on my own and with many residents over the years, I have reduced implant initial failures to 2 categories: 1) infection failures and 2) integration failures. Infection failures due to contamination at placement tend to have an enveloping radiolucency, and may or may not have suppuration. If the implant is removed and no threads remain, it is probably due to infection. Once contaminated, cannot be treated.


Treatment for infection failures is prevention - better sterile system and technique, and antibiotic preload, with or without post-load. I use Amox 2 gms for single load, or 1 gm plus post load (500 did for 5 days)

Failures to integrate may be micro-movement of the implant, overheating of bone, or that elusive one: bad luck. 

Movement: If you drill your holes round, and the implant goes in smoothly, I think movement is rarely the problem. Implants don't even need to be tight to not move. Of course this is less true for immediate relines or loads. At UW, we try to use Essix or bonded provisionals rather than temp partials.

Heat: When I consulted for a company, the #1 failure of this type seemed to be heat. Recommendations: Change drills often, especially the small diameter ones that are used over and over. Use manufacturer recommended drill speeds. Don't go slower or faster. Drill rake angles, etc. are designed specifically. Make sure staff allow implant kits to go through full dry cycle in autoclave. Opening early traps steam and water in the kit, and micro-corrosion dulls drills.

Luck: Probably relates to the above, but in small, cumulative amounts, so that "perfect" technique still sees 1-2 % failure. Patient factors come in here, which is why we tend to see cluster failures in one specific patient.

I'd start by replacing drills!


Hope this helps!

6/17/2011
Been doing a number of guided surgeries lately. Computer CAD/CAM fabricated guides have a great role but they are not for the faint of heart. My total is approaching 25 cases and each has been like giving birth – lots of work, nausea and planning, then time spent waiting and in anticipation, then finally a brief, painful experience resulting in a beautiful bundle (of implants).
6/17/2011
A resident came to me with a new case. A general dentist (student) referred a case with a plan to place a lower left first molar implant. There was a cast with a surgical guide on it. A 12 mm long molar had been waxed, and a 2 mm hole drilled 4.5 mm distal to the mesial contact. The guide is vacuum formed with clear acrylic filling the proposed tooth site. On the cast, I used my “thumb test.”
6/13/2011
A 90 year old man needs an extraction. He is medically fragile with a history of heart attacks, including fairly recent. He takes antihypertensives as well as Coumadin (i.e. the “C”, which is also called warfarin) and aspirin. He is alert and consents to care.

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Case Blogs

1/20/2014

6/17/2011

6/17/2011

6/13/2011

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