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andanbcx posted an update
Not the best outcome… dont really know why. So I completed this implant with sinus bump using the Densah system about a month ago. Everything went pretty straightforward. Got my little lift and placed the implant with great (maybe too great) insertion torque it measured out at about 60ish but i remember wanting the implant just a little more subcrestal and i torqued it a little more 🙁 pt came back for 2 week post op and pt reported no pain or discomfort. Then she comes back 4 weeks after untial implant placement with the implant in her hand. I made sure i asked her if she followed all protocols after placement and she admitted that the day after she began an intense workout routine at her local crossfit gym. Looking at the amount of boneloss around the implant im thinking pressure necrosis? Anyone have some ideas?
After she came back i opened the area curretted all the granulation tissue and placed some bongraft to rebuild the arch
Thanks
Jedediah, Ivan and Erick8 Comments-
What size was the implant?
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And what was the torque when it went in? Randon stuff happens but I’d graft and come back in after a few months. Keep 1.5 mm around the implant with good irrigation
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4.3x10mm initial torque was 60ncm. I was wondering if it could have been her working out hard? Maybe worked her sinus too much?
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@andanbcx honestly that might have played a role. Patients tend to under-state their non compliance. If they went on a hard run they might say they went on a light jog.
So if your patient said she did an intense CrossFit session, it must have been pretty intense. And that goes against all post op compliance protocols.
If a patient is holding their breath while doing heavy lifts, I’m sure it can put pressure on the implant site, especially if you’re in the sinus.
It’s okay man, just time to rebuild and reemphasize patient compliance. But also to re-examine for any risk factors that might have been missed. Medication? Vitamin D deficiency? Diabetic?
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That postop x-ray looks so good., It’s painful to see what followed. I think it’s a bone Vascularization issue around the Implant. With versa you already compacted the bone, and then getting high torque further compacted it leaving little blood supply to the implant surface.
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Thanks for the insight. You’re 100% right with the bounce back from the versah burs I bet it was just too much. Broke my heart when she came in tho not gonna lie
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This has happened to all of us. We place the “perfect implant” and something goes bad. You’ve taken the right steps with debridement and bone grafting—just ensure strict post-op instructions moving forward. This happens even in the best cases—stay encouraged! Give it some time and re-implant.
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Over torque when using versah burs can become a problem and cause implant failure due to poor blood supply. I would try to keep torque around 50N/cm or below in the versah cases.
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