Dentaltown August 2019 - 42

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6D1R3
Member Since: 03/02/06
Post: 26 of 87

Just a quick follow-up. The patient was in Friday and the implant was still solid and asymptomatic, so we exposed and there was a moat-type defect around the distal extending to the
buccal and lingual (looked like the gap around an immediate implant). So we tried to graft it
and we'll see in a few months if it worked or not.
Here is the postgrafting X-ray. ■

5/5/2019

lomb
Member Since: 09/24/05
Post: 36 of 87

There are a million opinions here, but the only one that counts is that according to the lit,
you need ideally a 2mm bone border crestally buccal and lingual. If you don't have it, you need
to graft/membrane either via GBR ridge split or onlay grafting. ■
5/7/2019

Mark-LSU
Member Since: 08/22/06 |
Post: 62 of 87

To sum up what seems to be the case:
1. The initial implant placement and subsequent healing resulted in a "crater" or "moat"
defect round the implant neck, likely caused by less bone buccally and lingually at the
time of placement than may be ideal (2+mm buccally and lingual). Preoperative CBCT
scans can assist with planning in these cases to get the implant placed apically enough,
sometimes with concurrent ridge modification, or flattening. Chalk me up as someone who
has had this scenario occur with a patient of mine.
2. Now that the defect has formed, the OP has tried to graft the area where the moat defect
occurred. Some posters think it's worth a shot, others think removing the implant and
replanning and replacing is the way to go. The OP still has the option to remove and
replace if the graft doesn't result in an ideal scenario.
3. The OP has been extremely generous with his/her time in replying to this case and
providing further information for evaluation and learning, and has maintained a cordial
and professional tone throughout. As one can see from reading the thread, that is no
small feat. ■
5/30/2019

6D1R3
Member Since: 03/02/06
Post: 63 of 87

Mark, great summary! I am pretty new to placing implants and have learned a lot from
seeing other people's failures on DT, and figured I would post the case so that I as well as others
can learn. I will say certain comments are interesting and eye-opening. (I never would have even
thought the retained root would be an issue; others disagree.)
In retrospect, I possibly should have placed a 3.7x10 instead of a 4.2x8. Or maybe countersunk the 8mm implant another millimeter or two. My thinking (which I am sure some people
will disagree with) is that in areas of concern-here being above the mental foramen-I like to
be a bit more cautious. Maybe I am too new and inexperienced to be more daring. But I probably
had about 12-13mm to the foramen, and because I use the Densah drills which have a tip
that extends about 1mm past the indicated length and I might get into the safety zone placing
a 10mm implant, I chose to place a shorter implant-especially after seeing all the posters
here on DT whom I respect who are placing 8mm implants and considering them regular, not
short, implants today. However, I still wonder if the failure was, as previously mentioned, from

AUGUST 2019 // dentaltown.com

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Dentaltown August 2019

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