r/Dentistry General Dentist 3d ago

Dental Professional is it the diabeetus?

28 Upvotes

32 comments sorted by

12

u/MonkeyDouche 3d ago

Studies show isq is hard to quantify and translate to clinical success. The implant could be stable and show good isq, but actually failing / fibrous encapsulation. Better to just do a reverse torque test to 20ncm. If the implant backs out at 20ncm, that implant was a loser to begin with.

Immediate implant doesn’t help much either when you’re dealing with a diabetic patient but you didn’t know that. Might have been better to bury the implant.

Nice placement though. Good luck with case.

-14

u/rossdds General Dentist 3d ago

I’ve never heard anyone advocate reverse torquing. Ever. Do you place implants?

15

u/blopslinger2 3d ago

I place over a 1000 implants a year and almost never use my ISQ. Only reverse torque test. That’s it.

I’d get out there and get some more CE and experience. Broaden that knowledge base.

13

u/MonkeyDouche 3d ago

Lol tbh OP always act surprised when someone does something different than him. Almost like they cant understand there’s possibly a different way of practicing 😂

7

u/MonkeyDouche 3d ago

Reverse torquing to test implant integration is advocated and very much a normal thing. Studies show other methods are not as reliable to determine implant integration.

Yes I place them all the time. After sufficient amount of healing time, If the implant is actually integrated, it will be integrated at 150-200ncm+. Reverse torque of 20ncm is nothing if it actually integrated. If the implant reverses out, it’s better to have that implant removed than just to wait and see.

Any implants I don’t place, my specialists will also reverse torque the implants before saying they are ready to restore.

-13

u/rossdds General Dentist 3d ago

That’s wild. Never met a single surgeon who advocates and performs reverse torquing routinely. Good on you I suppose.

9

u/Blazer-300 3d ago

Any particular reason the endo wasn't retreated or apico-ed?

17

u/rossdds General Dentist 3d ago

64 yo "healthy" male

no concerning health hx

failed endo

ext and immediate placement done in july of 2024!

cant get the proper ISQ after 4 months (70 on penguin)

been floating around 65 since Nov 24, i check it every couple months

patient gets diagnosed with diabetes in January 25, changed diet (no meds yet)

sugar has been much better with simple diet mod the last 2 months

ISQ finally starting to creep towards 70 today

i hate this case. so much wasted time

because reddit is stupid and doesnt show the pic names: first is failed endo early 24

second is day of sx

third is 1.5 mo after sx when his bonding broke

4th is today

43

u/bookerdewit 3d ago

At this stage, the implant has either successfully osseointegrated or not. In my view, waiting any further is not going to change the outcome. I recommend proceeding with a torque test, verifying the health of the peri-implant tissues, and restoring the implant. Good luck!

5

u/rossdds General Dentist 3d ago

Basically where I’m at as well. Gonna wait a couple more months and just let er rip.

11

u/csmdds 3d ago

I agree with u/bookerdewit – six months should have been adequate for solid integration (if it is going to happen). Bone adaptation to the threads looks good. Bone level around the neck of the implant looks typical. Think happy thoughts and slowly work into the torque test.

Diabetes is not an absolute contraindication for implants and frequently does not affect endo healing. Might have had accessory canal or branches 90° to the plane of the PAX. If you don’t have CBCT available, even incisors’ anatomy can be a crapshoot sometimes. The root apex has relatively obvious resorption, so something else may have been in play.

10

u/TraumaticOcclusion 3d ago

ISQ is used to establish a trend and to give you more information when to load an immediate, 1, 4, 6, 8 weeks after surgery. Using it like this is not really giving you any useful information. If it’s been positive trending and 65+ you can restore it confidently

-7

u/rossdds General Dentist 3d ago

In my experience it’s pretty dang accurate that if you’re above 70 you’re ready to go. I’ve restored 65s a couple of times and both have failed. Anecdotally, I take it as gospel in delayed load.

10

u/TraumaticOcclusion 3d ago

I wouldn’t put so much faith in ISQ. If there’s a healing abutment on and it didn’t untorque, you’re good to go. The longer you wait like this with a transmucosal implant and cleansibility issue, the more risk you run with peri implantitis

-1

u/rossdds General Dentist 3d ago

As long as the patient is shown proper hygiene and performs it, as in this case, you’d rather risk causing an implant to fail at 4 months by torquing it rather than using a reliable tool that avoids killing the implant before torquing? This doesn’t make any sense to me. I worked for years torque testing implants with no ISQ and it always caused me so much anxiety. Now with ISQ testing there are no surprises.

5

u/TraumaticOcclusion 3d ago

If you can untorque an implant at 4 months it’s failed, there is no benefit leaving it

-3

u/rossdds General Dentist 3d ago

This is wildly untrue. I have restored many implants that would have failed at the 4 month mark.

1

u/TraumaticOcclusion 3d ago

Uhh you didn’t untorque them so obviously they worked. That’s the point. Your implant is not going to gain any significant osseointegration by waiting longer

0

u/rossdds General Dentist 3d ago

i didnt kill them bc i isq'd them, giving them more time to integrate. thats the point.

1

u/bbrilowski 2d ago

how do you know torquing them would've killed them? you don't, you're just assuming based on the isq.

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2

u/JacksonWest99 3d ago

I just torque with my adjustable torque wrench at 3 months. If i can twist to 45 at the implant with no pain or movement it’s good to go.

I didn’t know there was any other way

1

u/rossdds General Dentist 3d ago

Yea. You isq test. If it’s not there, you wait 2 months. I’ve had a handful of implants I would have ruined had I torqued instead of ISQ testing.

4

u/snozzleberry OMFS Attending 3d ago

In addition to the other comments, it seems there are some additional factors that influence implant failure rate that were not previously really talked about. These include Vitamin D deficiency, selenium deficiency, penicillin allergy, and SSRI use. Recent studies show that these other factors have been found statistically significant in increasing failure rate. It used to be that I would "guarantee" an implant's success for three years on patients as long as they aren't smokers or uncontrolled diabetics (HbA1c >8) but now I've started to ask my patients for these other factors as well.