it was a slam dunk case that I rushed through. =/ Drilled to 9.5 – 10 mm, and placed a 9 mm implant. Clinically, I torqued it down to 0.5 mm subcrestal. It seems like it’s at the crest or slightly supracrestal. lol Did it ever happen to you guys? It’s been a week. Should I take it out, and then prep 1.5 – 2 mm deeper, and place it deeper? or just let it heal? any thoughts?
Ivan:
This is an awesome question and no worries it happens all the time! Let me break this up for you into a few parts.
Subcrestal placement of platform switched implants can help to prevent thread exposure. The site may still experience bone loss but you will likely have less bone loss around the margin of the implant. (exposing titanium). Randomized control trial:
https://pubmed.ncbi.nlm.nih.gov/25041252/
Exposed implant threads are opportunities for bacterial accumulation. So, yes, it is preferable to not have exposed rough surfaces of the implant. Source:
https://pubmed.ncbi.nlm.nih.gov/23694907/
I don’t think that this is a huge deal in the big scheme of things. Your implant will osseointegrate. You may have a little bit of thread exposure, but nothing egregious. You can do extra-vigilant maintenance for that patient and bring them back more regularly and take follow up PAs. My guess is that with proper maintenance and hygiene, this depth issue wont be significant.
Here is an example of someone else’s case who asked us the same thing:
https://www.notion.so/implantninja/Not-deep-enough-should-I-redo-0a63f297b43e42879c40aea6ac8a8254
Joelle:
I agree with a lot of what Ivan said! If this were my case, I would leave it and let it heal. From the CBCT it looks like maybe only 1-2 threads would be exposed.