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Endo tips    Better Endo    Endo abstracts    Endo discussions

Woops with implant 1st - Courtesy ROOTS
The opinions within this web page are not ours. Authors have been credited
for the individual posts and photographs where they are. Photo courtesy: Alan Cady - www.rxroots.com
From: "Alan Cady"
To: "ROOTS"
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 representative here. 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

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