Immediate Loading of Edentulous Mandible with Implant Failure Fixed with Bond ApatiteŽ

Male, age 70 years. Clinical interview: diabetic, high blood pressure, acute coronary syndrome two years ago with PCI (percutaneous coronary intervention). The teeth in the front mandible were not in good position to use them with new prosthetics. We decided upon extraction and immediate implant placement with temporary overdenture. After extraction four implants were placed in positions 34 (21), 32 (23), 42 (26) and 44 (28) with good primary stability (Ires System, D-3.7 mm, L-11.5 mm). The empty alveolars between implants were filled with Bond Apatite®. The temporary overdenture was fixed on temporary abutments. 3 months post-op the four locators and new overdenture have been done.

During a follow up visit 3 months later the patient reported a growing pain of the left site (position 34 (21)). The mucosa was also painful with even a gentle touch. On x-ray only the little inflammatory changes were visible. When I tried to unscrew a locator, I took out the implant. I removed all inflammation using local anesthesia, then I inserted a new implant (Ires System d-4.1mm, L-10 mm) without good stability because of bone damage around by periimplantitis. The empty space around the new implant was filled with Bond Apatite®. Three and half months later I uncovered the implant and screwed a healing abutment with 30 Ncm! (We also changed the locators to ball abutments to make stronger stability of the new overdenture). In the next 2 years follow-up no implants were lost! No more of periimplantitis changes were observed.