r/Dentistry • u/Mainmito • 22h ago

Dental Professional Just placed and implant and it's very loose

I just placed an upper first molar implant and the implant is very loose but barely able to put on a cover screw. Patient has no relevant medical condition and is a 60 year old lady.

CT scan shows a very wide ridge but no trabeculation at all, just completely radiolucent. When I did my osteotomy, it just dropped in after piercing the cortical bone and subsequent drills had no resistance at all. So I prepared a 4.5mm hole and placed a 5.5mm diameter implant and it still didn't have adequate primary stability.

I'm just very perplexed. What would be the cause of this, what could I have done better or prepared better and how should I go ahead with this case?

6 Upvotes

80% Upvoted

13 comments sorted by

22

u/tique_dds 19h ago edited 7h ago

Bury it and let biology work. I had a patient that had just completed ortho treatment. Patient had styrofoam bone. It was a spinner. I buried it and then 4 months later I got an ISQ reading of 85 with zero bone loss.

3

u/flissat 9h ago

ISQ of 85 after a spinner is wild, thats really reassuring tbh

14

u/Playful_Quality4679 19h ago

I don't worry too much about primary stability. It could still integrate and last a lifetime. Just don't load too early.

3

u/Mainmito 19h ago

In this case, how long would you wait until you scan and load it

9

u/ManuelNoriegaUK 17h ago

6 months to be sure

5

u/N4n45h1 General Dentist 20h ago

The bone is often super soft in this area. You could have prepared your osteotomy smaller, but what I would have done is used versah densah burs after the initial osteotomy.

All you can do now is bury it and pray.

3

u/SwampBver 18h ago

Like everyone else said, give it time. Or put a fatter implant in a skinnier hole. Or osseodensification via versah burs, my personal favorite

2

u/Mainmito 18h ago

How long should I wait before calling the patient back to scan?

2

u/Thepres_10 17h ago

Safe side 6 months or so

3

u/asdfkyu 18h ago

“Spinners” are fine as long as they can’t move vertically/horizontally and are encased by bone. Just bury it and let the body heal

1

u/Lower_Plankton_2699 7h ago

Are you sure you didn’t place it in the sinus…. Please share a radiograph

0

u/ToothDoctorDentist 16h ago

Switch to versah. Buy an osteotome and mallet.

2

u/shtgnjns 13h ago

Patients absolutely hate osteotomes if you're doing this under LA. Densah burs are definitely the better option, haha