Woops with implant 1st - Courtesy ROOTS
From: "Alan Cady"
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Photo courtesy: Alan Cady - www.rxroots.com
Sent: Saturday, September 02, 2006 8:30 AM
Subject: [roots] WOOPS with implant 1st
I am sending one of my problem cases. This is an implant case I DID,
but not well. I hesitate to send due to the discussion on implants,
but this was NOT the implant but case selection and timing.
I did an immediate placement after extracting 2 and 3 and then
perforating the sinus in with the last twist drill. I had pushed up
the sinus but had not place anything to protect whilst I just stuck
in the twist drill. STUPID to the max.
Next I place the membrane (too late now) then added some graft and
inserted the implant. Placed the cover screw and the patient went on
his way to CHINA for a couple months and then returned 4 months later
for the first post op. Symptom free but The post insertion X ray that
day just looked 'funny'. I re checked it at 6 months and exposed took
off the screw and torqued to 30 N, or at least that is what I wrote
down. Today. I again exposed, checked to see if it was solid and firm
and it seemed OK but the sound was a bit off. I removed the cover screw,
placed the attachment abutment, and hand tightened. NEXT I pushed on
the torque and WOOPS, it all pushed up.
I then did a 2nd div block, explained what that funny feeling was to
the patient, and did a lateral opening and retrieved the implant grafted
membranes and closed, This time I did not perf the sinus in pushing up
the implant or opening to retrieve my screw up. I Rxed meds, prednisone,
pain pills and OTC nose spray.
This patient is the younger brother of my first hygienist when I moved
to OKC in 1977.
NOW the point. Surgery skills are important to any of this stuff.
We have to know where to place the implants and we have to not be in a
rush as I was. We also have to have the skills to fix our screw ups when
they occur. So if one can not address these problems it may be best to
refer to someone that can.
This is me naked, and it is hard to post, but I learn from my mistakes.
Hope this saves someone else from one - Alan Cady
This happened to a friend of mine who on the advice of an oral surgeon,
opened a window above the molar and put a high volume suction in to
extract the loose implant in the sinus. He couldn't believe how far in
the suction went though - John
Alan, What a great learning case. This is a good example of the bad
things that can happen in implant surgery. This is also a good example
of how to salvage the situation. I have never had this happen to me but
I have learned a lot from what you posted. Even though implant surgery
can be more direct now than in the past with the advent of CT scans
and virtual treatment planning software you still have to know how to
do the surgery to handle situations that don't go well, Thanks for
sharing - Arturo
Alan, the oral surgeon I refer to has had the implant end up in the
sinus too. That is great that you can do a sinus approach surgery and
recover. I think the oral surgeons or periodontists should be ready
and willing to help us if we don't do that particular recovery procedure.
Especially the ones that we have sent many other cases to for reasons
other than something like this .
We all have failures with every type of procedure. This is no reason to
limit ourselves in learning new techniques. I think it is great that
you shared this case. Where did you learn to enter the sinus ?
Do you do sinus lifts ? - Dr. Danny O'Keefe
I agree to a most of this point, but one must have a good relationship
with a surgeon to fix the problems beyond our comfort. I have that
possibility with some endo, but find I usually refer only cases I have
not got the time to do. That is good for Dr. Duke.
I do sinus lifts, I quit when I had someone here to place implants,
but to my benefit, I found I did mine as well or. . . I find PepGen
Putty 15 mixed with either the patients bone or synthetic bone worked
well. Smiler like pepgin putty on Sinus lifts even though it really
does not resorb and get replaced with new BONE. Smiler also developed
a neat balloon to lift either laterally or through the socket. They
were (are) working on one with a membrane already attached . ON my screw
up, I placed a barrier even though the sinus looked in tacked placed
pepgin deep, covered that with allograft neat the PATIENTS BONE and
another membrane. Closed completely and place Cyano acrolate over the
sutures and X rayed.
Before I went lateral I tried to retrieve via the 'socket, but even
thought the implant took a dive up, I could not get even the smallest
hemostats up into it. I never tried just a small suction, but there
were still some screw marks on one side of the bone.
A also do new techniques, but Salvin and others make models I use to
play on. THAT is where I did my first sinus and 2nd and 3rd lift.
I LIKE the models Smiler has best, but cadavers are most
I first went into the sinus 30 years ago in Waterloo with Dr Rick Foster
near by. I did some root tip removals and one biopsy over the years also.
I am more afraid of a lingual vertical releasing flap that the sinus,
but I am not as skilled as those doing the lingal release - Alan Cady
Alan, PepGen Putty 15 + What synthetic bone do you like ? The synthetic
bone must resorb to be able to place an implant ? About 6 months
integration time for the sinus lift ? - Dr. Danny O'Keefe
Thank you for this Alan.........It's easy to show excellence, much
harder to show learning how to be excellent. Takes
more guts - Kendo