Dentaltown December 2019 - 48

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Then I try the abutment on, and I remove the screw and using a putty matrix I created in
the beginning, I fi ll that matrix with Voco temp material and let it auto-cure on the abutment
in the mouth.
The matrix is then removed and, using a hemostat, I remove the temp with the abutment
stuck to it. I open a screw access and finish the temp on the abutment outside of the mouth using
flowable composite. Once the temp is looking good, it is reinserted on the implant and the screw
is hand-tightened. The screw access is closed with flowable. And that is it.
Once healing is confirmed at the two-month mark, an appointment is given to do a crown,
which usually puts us at the three-month mark. At that appointment, the temp is removed, and
the abutment is removed. Then, a crown is made with Cerec, with a screw access. The abutment
is in the mouth at this point, so the crown is cement on the abutment in the mouth. Then the
abutment is removed with the crown cemented on it, cement is cleaned up, the implant platform
is checked, and afterward that crown and abutment are repositioned and the screw is torqued at
30. Then the access is closed with composite. ■
9/25/2019

wilddoc75
Member Since: 09/29/13
Post: 12 of 68

I stopped placing immediate implants for this reason, as have many oral surgeons in my area.
An extraction site can be just too unpredictable. Bacteria, questionable stability, dead space,
infected/necrotic bone, etc. I can count on one hand the number of implants that have failed
to integrate when done traditionally. In fact, the last one was three years ago (now frantically
looking for wood to knock on), and he was a previous cancer/chemo patient.
With immediates, I had a span of six months where I saw maybe five to seven placed in the
previous two to three years that failed in similar fashion. Came out easy and completely clean
with just epithelial attachment, no sign of infection. Also no sign of bony attachment.
In fact I just had one, #14, that was placed by the local OS. Everything appeared OK until
I placed the impression coping. Patient felt a little ache, then as I tried to remove it, she winced
in pain for a second and the whole thing twisted out, imp coping and all. Implant was sitting
in there for more than six months, no integration at all, but damn if it didn't look good on the
radiograph.
Even in a scenario where I had to place an immediate I would graft the heck out of the
socket. Get a great membrane in place and bury that sucker so no oral bacteria can get to it. I
have colleagues who will routinely place immediates and have that big healing cap sticking up,
thinking that they are going to save some time on the back end. Those suckers allow so many
bugs to colonize around that collar. ■
9/25/2019

mlau
Member Since: 11/08/08
Post: 13 of 68

Hey, Karim, This is not that bad. It's a known/possible complication of immediate restoration of an implant. There's always a possibility that the patient did something stupid with it,
like open beer bottles. I wouldn't kick myself over this. It would be nice to have more info so
that I can learn from your experience. ■
9/25/2019

johnstondmd
Member Since: 09/10/13
Post: 14 of 68

I know you know what you're doing, so my questions are just thinking out loud.
1. What's your degranulation protocol after extraction?
2. You didn't mention grafting the gap.
3. What kind of defect remained when you saw her after the implant was lost? Was the buccal
plate still there with no fenestration? ■
9/25/2019

DECEMBER 2019 // dentaltown.com

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Dentaltown December 2019

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