Implant placement is the gold standard in permanent restorative treatment. Its popularity is largely due to high success rates documented in countless studies over the decades, including in Quintessence’s own journals. Still, implants are not exempt from complications or failures. Even the most skilled clinician cannot always prevent mechanical or biologic problems from wreaking havoc, and osseointegration failure, fracture, overloading, and peri-implantitis can compromise an implant before it has a chance to fulfill its functional, esthetic, or phonetic purpose.
Even though another implant can be placed at a failed site, the survival rate drops with each subsequent placement. Maybe that’s why a recent PRD article stood out: Not only did an implant site endure four implant failures, but it lived to tell the tale of a successful fifth implant placement.
The patient was understandably skeptical of yet another treatment attempt, but he managed to push the distrust aside and try again. Drs Al Khalil, Leung, Bergamini, Yu, Froum, and Cho were determined to succeed.
The lateral window approach for maxillary sinus augmentation was the treatment method of choice to ensure a successful case. After creating a buccal flap, the sinus membrane was elevated for the implant osteotomy. The implant was placed using a submerged approach, achieving good stability by engaging the maxillary sinus cortical floor, and the residual spaces were grafted with xenograft. Primary closure was achieved, and the site healed uneventfully for 3 months, at which time second-stage surgery was performed. A zirconia crown was then utilized to restore the site, and the patient was given a nightguard to counteract their bruxing habits. At the 1-year follow-up, the implant and prosthesis were functioning well, and no marginal bone loss was seen.
Four previous implant failures may result in a less-than-favorable prognosis, and many readers likely shared the patient’s skepticism and uncertainty of success. But I guess that old saying is true: If at first you don’t succeed, try, try again. With simultaneous augmentation at implant placement, good initial implant stability, and perseverance, even the most unlikely cases can achieve positive outcomes.
Check out the May/June issue of PRD for all the details on this success story, or be sure to grab a copy at the 14th International Symposium on Periodontics & Restorative Dentistry next week. We hope to see you there!
Dr Leandro Chambrone received a DDS and a Certificate in Orthodontics and Dentofacial Orthopedics from Methodist University of São Paulo in Brazil. Subsequently, he earned a master’s degree and PhD degree in periodontics from the University of São Paulo. He serves as a faculty member in several prestigious institutions in North America, South America, and Europe. He holds positions of Associate Professor at Egas Moniz University (Portugal), Ad honorem Associate Professor at El Bosque University (Colombia), Visiting Professor at the University of Iowa, and Adjunct Associate Professor at Penn School of Dental Medicine. Beyond his enthusiasm and dedication as an educator and health care provider, Dr Chambrone is also heavily involved in clinical research and evidence-based dentistry. He has authored over 150 papers, including some commissioned consensus reviews for the American Academy of Periodontology and the European Federation of Periodontology. Dr Chambrone currently serves as Section Editor of Clinical Research for The International Journal of Oral Implantology and Section Editor of Periodontics for the Journal of Esthetic and Restorative Dentistry.
Dr Gustavo Avila Ortiz obtained a DDS degree and completed his PhD at the University of Granada (Spain) before moving to Ann Arbor, Michigan, where he completed an MS degree and a Certificate in Periodontics at the University of Michigan. He has over 10 years of experience as an educator and has worked to advance the profession as a member of numerous institutional committees and scientific organizations; he is also a Diplomate of the American Board of Periodontology. He was a faculty member at the University of Michigan School of Dentistry and at the University of Iowa College of Dentistry, where he was the Phillip A. Lainson Professor and Chair of the Department of Periodontics. Dr Avila Ortiz serves as Associate Editor for the Journal of Periodontology and Co-Editor for Clinical Advances in Periodontics, the official journals of the American Academy of Periodontology. He has authored more than 100 articles published in peer-reviewed journals as well as several book chapters. Aside from being regularly engaged in scholarly, administrative, and continuing education activities in different academic institutions, Dr Avila Ortiz maintains a private practice limited to periodontics and implant dentistry at Atelier Dental in Madrid, Spain.
Edmond Bedrossian, DDS, received his dental degree from the University of the Pacific, and completed his oral and maxillofacial residency at Alameda Medical Center. He is a professor in the department of oral and maxillofacial surgery at the University of the Pacific School of Dentistry, as well as the former director of implant surgery at Alameda County Oral & Maxillofacial Surgery training program. Dr Bedrossian has authored multiple articles and chapters as well as two books on the various uses of dental implants including bone grafting, immediate implant placement, and treatment of the fully edentulous patient with tilted as well as zygomatic implants. He serves on review boards for multiple peer-reviewed journals and is a diplomate of the American Board of Oral and Maxillofacial Surgery and an honorary member of the American College of Prosthodontists. Dr Bedrossian maintains a private practice limited to implant and oral and maxillofacial surgery in San Francisco, California.
Edmond Armand Bedrossian, DDS, MSD, is a board-certified prosthodontist and currently practices in his hometown of San Francisco, California. He received his DDS from the University of the Pacific Arthur A. Dugoni School of Dentistry in 2015 and completed the advanced prosthodontics residency program and received his master’s degree at the University of Washington, where he is currently an affiliate assistant professor. He is a diplomate of the American Board of Prosthodontics and has authored various publications on removable prosthodontics and treatment planning the fully edentulous patient. He has lectured nationally and internationally on implant and prosthetic dentistry. Along with Dr Ryan Mizumoto, he co-founded D365, a social media application providing a networking platform for dental students, residents, and dental practitioners.
Lawrence E. Brecht, DDS, received his dental degree from New York University College of Dentistry and completed his prosthodontics and maxillofacial prosthetics residencies at the Veterans Administration Medical Center in Manhattan. Dr Brecht is currently the director of maxillofacial prosthetics at Lenox Hill Hospital, Long Island Jewish Medical Center, and North Shore University Hospital of Northwell Health, the largest hospital system in New York State. In addition, he serves as the director of maxillofacial prosthetics in the postgraduate prosthodontics program of NYU College of Dentistry, where he is an adjunct associate clinical professor of prosthodontics. Dr Brecht has authored multiple articles and chapters on the maxillofacial reconstruction and oral rehabilitation of patients with cancer or craniofacial anomalies and is on the editorial review boards of several well-regarded journals. He serves as the president of the Maxillofacial Foundation as well as NextGenFace Foundation. Dr Brecht currently maintains a private practice limited to prosthodontics in New York City.
Ronaldo Hirata, DDS, MS, PhD, finished his 4-year DDS course at the Federal University of Parana in Curitiba, Brazil, in 1995. After completing his degree, he undertook a 2-year operative dentistry specialty at the same university and began lecturing internationally, with a focus on esthetic dentistry. Dr Hirata has now lectured in more than 40 countries and maintains a private practice limited to esthetic dentistry in Curitiba. To improve his scientific knowledge, Dr Hirata finished a master’s degree in dental materials in 2003 at the Catholic University of Rio Grande do Sul, with a research thesis working with glass and polyethylene fibers to improve mechanical properties of composites. His PhD in restorative dentistry at the State University of Rio de Janeiro was completed in 2009, with research focusing on the transmittance, reflectance, and fluorescence of composite resins. In 2012, Dr Hirata undertook a postdoctorate at New York University (NYU) working with plasma application on dentin surfaces and bonding strength analysis. Now, he is Assistant Professor in the Department of Biomaterials at NYU with a secondary appointment in the Department of Cariology. Dr Hirata has published more than 100 papers in English, Portuguese, and Spanish, and his previous books (TIPS, Artes Medicas, 2014; Shortcuts, Quintessence, 2017) were both published in three languages.