Ivan:

Here’s what I would do:

Option 1:

Put patient in regular denture for lower arch. Place 2 additional implants and sleep them. Uncover 4 months later and start restorative process from scratch.

Option 2:

Place 2 additional posterior implants and attempt to immediate load those two. Then wait 4 months and start restorative process from scratch.

I have done it both ways and I can say that it depends on your appetite for risk. These days, I like to have the minimum risk level possible as that translates to the minimum headaches for me.

If there was not more bone posterior, I might just go with 4 right anterior to the mental foramen. So I could just place a couple more anterior implants. That is how Brannemark originally did the All on 4 cases back in the day.

PRO TIP: When you do get a failed implant for a full arch, know that the implant itself is not the biggest concern. You can place another implant and get that one to osseointegrate. However you should also be concerned about the health of the temps! Placing another implant means you’re expecting those temps to hold up for an extra 3-4 months. I would look at those and see if they need to be touched up. It may be worth sending to the lab for reprocessing.

if you send to the lab for reprocessing of the temp then the patient is going home edentulous until it returns. That’s why sometimes it helps to have 2 sets of immediate temps made so you have a back up just in case. But otherwise, I would put some healing abutments on those multi unit abutments and send the patient home for a day and return the next for the reprocessed temps.

They may not like that, but the teeth would be waaaay stronger than trying to do it in house.

Jesse:

Great question! I agree with everything Ivan said. It really depends on the timing of the failure and the integrity of the temporary. I’d also be interested in trying to figure out why these failed.