A CASE OF WHY IMPLANT DOES NOT OSSEOINTEGRATE

[DrAnil]

I treatment planned this case for 2 implants to be placed 8 weeks after extraction of #4, 5 [maxillary right first and second premolars]. After extracting #4, 5 I thoroughly debrided the extractions sockets.  I then drilled the osteotomy sites and installed 2 Osstem implants — a 3.5×10 and a 3.5×11.   At the time it was somewhat difficult to achieve good anesthesia for the #5  site and because of that I was unable to torque the implant to  35Ncm and I did not achieve good primary stability.  The post-op period went uneventfully but at  2 weeks you could see the cover screws; she was wearing a flipper (not relined with soft liner but relieved for pressure).   After waiting 4 months you can see on the radiograph, a radiolucent area around implant #5, especially on the mesial. At the 2nd surgery I torqued down the implant  35Ncm.  This went well and there was no mobility, no suppuration, no symptoms but I still decided to remove it, which I did with reverse torque. Could the implant diameter have been a problem in this case? should I have placed a 4.0/4.5 instead? How can you be sure the periapical pathology has resolved before placing the fixture? Helpful comments and suggestions are very welcome.

        

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