The First Case of Implant Failure: No Primary Stability

The 82-year-old male patient is a bruxer.  The porcelain-fused-to metal crown of the tooth #12 (Fig.1 C) fractures (Fig.2).  One month after extraction (Fig.3 arrowheads: healing socket), a 4.5x17 mm tapered implant is placed without primary stability (Fig.4: I).  The last osteotome used to form osteotomy is 5x17 mm.  The mistake is due to using a new implant system and technique. Two weeks later, an abscess (Fig.5: A) develops around the implant.  Finally the implant falls out by its own.  Two to three months later, a 5x20 mm round implant is placed (Fig.6: I) with high torque. Eight months later, a new crown is cemented (Fig.8,9: C).

It appears that the size matters.  Two years post cementation of #12 implant crown, the tooth #18 of this gentleman has endo failure.  A large immediate implant is placed without complication.

Fig.10,11 show the #12 implant in function 2 years 8 months whereas the neighboring fixed partial denture (#13-15) is broken.  In fact the crown at the site of #12 has been changed to Zirconia due to bruxism (Fig.11 C, as compared to PFM in Fig.8).  An implant is placed at the site of the pontic (Fig.11: #14) first.  By the time the implants at the sites of #13 and 15 osteointegrates, the implant at the site of #12 has been in function for 3 years 4 months (Fig.12). 

Implant Fails, Long-Termed Follow Up

Xin Wei, DDS, PhD, MS 1st edition 07/24/2011, last revision 06/21/2015