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QUARTER 4 | 2014 | CERECDOCTORS.COM | 55
honest, my gut says that’s best, as that bone is thin, particu-
larly compared to these behemoth-sized implants. So, you
might say the stability comes from the furcal bone. As for
I/A proximity, I think it is tooth to tooth. In my example
above, the root spread allowed me to have my implant
barely any more apical than the original tooth. However,
if you were replacing a tooth with more of a conical shape,
you might need to go longer, or perhaps wide might even
be better to establish stability. Another nice thing about
BSB’s price-point: at $135 for the implant, are you really
going to cry yourself to sleep if you have to toss one and go
up a size? Don’t know the prices for TriMax. Megagen has
some fatties and they are around $250, right? Maybe keep
one or two of those for backup if needed. But, honestly,
getting stability isn’t difficult AT ALL in my limited
experience.
T-Bone 3D Implant Agarwal | Raleigh, N.C.
I don’t really understand the benefit of these
“fatty” implants.
I get my stability from interseptal and/or apical bone
... That is “fresh” bone and the traditional size (5.0 to 5.7
implant diameter) is more than adequate here.
My concern with the “fatty” implants is that to utilize
the fat part for stability you are encroaching dangerously
on the plates.
Likewise, to get stability from the wide (some fatties are
not so wide at the apex) portion of the apical portion of
the implant, you have to drill away so much bone you lose
your stability.
That case I showed yesterday was drilled to a 3.0 mm
osteotomy and a 5.0 mm active implant was inserted —
more than 35 ncm of torque.
Emil Verban | Bloomington, Ill.
Baron, there are
many ways to
achieve the same outcome.
You can use bone-level or
tissue-level implants.
Here is a tissue level with
I think a good outcome.
Jeremy Bewley | Louisville, Ky.
I also have concerns with the wide bodies filling
the socket, as described by Tarun. Not that it
can’t or doesn’t work, but what happens if there’s a failure?
Complete loss of buccal or lingual plates? Migration into
the sinus? If so, what’s the incidence of these complica-
tions relative to a standard size implant surrounded by
graft and membrane? It seems that an immediate stan-
dard size, say a 4.6, placed into interradicular bone would
lose only that bone, leaving bony walls intact for healing.
A wide-body failure might risk a significant bony defect
that is very difficult to regenerate. But again, what’s the
incidence?
Good conversation, guys.
Baron Grutter
I completely understand the hesitations about
repercussions of implant failure. However, if I
may, let me show you two of my failures.
Firstly, my first immediate molar. Unfortunately, I frac-
tured the buccal plate during the extraction, placed pres-
sure up against the buccal plate with the implant, and then
had the tissue continue to tear through the sutures. After a
month, the implant was still rock solid, but it had buccal bone
loss of about 3 mm. So, I removed the implant, grafted and
replaced it a while later. Honestly, the bone healed just fine,
and probably no differently, had I grafted andwaited to place
the implant tobeginwith. So, Iwould say this is anexampleof
a failing “fatty” that did not destroy the entire alveolus.