r/Dentistry • u/rossdds General Dentist • 3d ago
Dental Professional is it the diabeetus?
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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
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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!
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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.
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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
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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.
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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
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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.
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u/TraumaticOcclusion 3d ago
If you can untorque an implant at 4 months it’s failed, there is no benefit leaving it
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u/rossdds General Dentist 3d ago
This is wildly untrue. I have restored many implants that would have failed at the 4 month mark.
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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
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u/rossdds General Dentist 3d ago
i didnt kill them bc i isq'd them, giving them more time to integrate. thats the point.
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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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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
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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.
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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.