Dentaltown December 2019 - 50

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Immediate anteriors with immediate temporization are very unpredictable, mainly because
of patient compliance. I don't care if you take that temp 3mm out of occlusion, patients will still
bite into anything and everything. Even the compliant ones will forget at times. So the chance
for micromotion during the critical biological healing phase is extremely high on an anterior
because patients can shift their mandible to line up edge to edge anytime they want. I quit
temporizing these things-I don't even do a flipper for fear of pressure on it. I do the Essix type
and hope for the best. How did the bone feel? Could you feel any threads still in the bone? ■
9/26/2019

eeznogood
Member Since: 02/23/06
Post: 21 of 68

So is it possible that an implant doesn't integrate but retains excellent stability for about a
year, even with a crown on it, normal function, all of the torqueing, removal of the screw, etc.? ■
9/26/2019

lomb
Member Since: 09/24/05
Post: 26 of 68

The implant was likely contaminated either pre-existing from the packet, from the extraction
site or from saliva. Basically, the body rejected it-osteoclasts outnumbered osteoblasts. Once
the body makes a decision on it, then that's what happens. No doubt the cells locally "talk to
each other and are on the same page." ■
9/26/2019

jakewolf
Member Since: 02/28/14
Post: 32 of 68

I had several failures with an implant that was popular here on Dentaltown. I switched
to AnyRidge and the failures went away. I'd just go back to Legacy if that worked in your
hands. I've heard that it's not uncommon to have many failures when switching to BioHorizons.
BioHorizons is clearly a great implant, but I've heard numerous people state that switching from
certain systems to BioHorizons results in higher failures until you figure out what you need
to change. You are clearly a top clinician; your work is some of the best on DT. I'm curious if
there is something to the clean implant thing. I forget the guy's name, but he did a podcast with
Howard and his group called Clean Implant, I found it interesting. I love the fact that you don't
just say, "It happens to everyone sometimes." The more people talk about and share failures, the
better off we all are, because we can make corrections. ■
9/26/2019

NeutrophilOMFS
Member Since: 07/08/12
Post: 34 of 68

I had this happen to me with a BioHorizons implant twice. Patient had nice bone levels and
good 30ncm torque test without anesthetic at three months. Six months after the restoration, the
entire implant-crown complex came out. There was a fibrous union encircling the implant with
minimal BIC. No way to know that without a CT or flapping the implant.
With BioHorizons, I've learned to always tap and use the final drill until it is completely
passive in the osteotomy and never insert with more than 50ncm. Haven't had a failure in a
while by doing this. I think the high insertion torque is nice but can overcompress the bone, and
you end up with a ring of scar tissue. ■
9/26/2019

pjmop
Member Since: 02/15/05
Post: 35 of 68

For what it's worth, my "rules" for immediates. It's typically 13mm long, engaging native
bone. And usually get a healing abutment. Not a tooth. Usually easier to graft and wait four
months, though. ■
9/26/2019

DECEMBER 2019 // dentaltown.com

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Dentaltown December 2019

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