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56 | CERECDOCTORS.COM | QUARTER 4 | 2014
| | | D I S C U S S I O N F O R U M
long implants, then that can potentially raise separate
consequences.
And, as far as not needing such a large implant to estab-
lish stability, as T-Bone mentioned: I completely agree. If
you can place a ~4.5 implant or so and get stability, great.
Personally, I’d probably prefer a good platform switch, so
5+ would be my preference in a molar, but still. However,
the “fatties” are more predictable, it would seem. And I’m
not real excited about wasting implants due to instability.
Even though I did previously mention it not costing much,
I do believe that approach would increase the odds.
Thomas Kauffman | Atlanta, Ga.
The Southern/Keystone TriMax large body is a
system worth considering. I have placed more
than 100, most immediates, and have had no failures or
problems. Any protocol or technique can be abused and
applied inappropriately with predictable problems. The
protocol for this placement has been discussed in several
threads and I won’t review those again. The advantages
are beyond those immediate molar spots. Placing a 4.1- or
4.7-mm implant in a molar spot, in my mind, is kind of a
300-poundwomanwalking on four-inch spikedhighheels.
The problem is that the interseptal bone is not always
there, especially in conical root form teeth, or especially
in second molars. In that scenario, you are left with having
to allow socket healing to occur and delaying the implant
placement — which is not the end of the world, but can
be predictably avoided with the TriMax, because rarely is
there inadequate socket support to prevent placement.
After almost 40 years in dentistry and restoring thou-
sands of implants, a major problem on the restorative end
has been inadequate buccal emergence profile and promi-
nence due to lingual placement and tissue deficiencies
that result not in six months to a year, but two to five years.
Additionally, many times the gingival embrasure becomes
problematic due to cratering and lateral food impaction.
The large body (most of the time I am using 8.0 x 9.0) with
placement protocols eliminates the need for gap grafting,
suturing, membranes, guides, etc. The cases I have been
following now for more than four years do not suffer that
same fate. The case illustrated created the emergence
profile I routinely get in molar sites without the need for
any bone grafts, membranes, etc.
Occasionally, as was the case today, when going to
placement after extraction and healing sometimes results
in a socket that may not be mature enough in density or
This is another failure. This was a traditionally placed
implant, 4.2 x 8. For some reason, when I uncovered it, it had
a 2-mm deep by 1.5-mm wide trough all around the implant
of soft tissue. After speaking with Farhad, I decided that
removing it was probably a mistake, but I had already done
so. This implant was rock solid, but I didn’t feel comfortable
treatingthesoft-tissue invagination(not infection). Since itwas
a well-contained socket, and I desired to replace the implant
soon, I did not graft and just placed a CollaPlug. As you can
see, my bone disappeared.
Quite humbling, actually.
Fortunately, the patient was
veryunderstanding.Weopted
for a new bridge (we were
replacing a defective bridge)
to avoidmore surgery.
Now, I completely understand that there are MANY
more factors involved in these cases. My only point is the
following: large-implant failure does not necessary equate
to an easily addressed socket, and large-implant failure
does not necessarily equate to massive bone defect.
Again, I know that my cases are purely anecdotal. But,
when we’re talking about replacing teeth that are FAR
larger than any implant we carry, I don’t seewhywe should
automatically assume that a failure will have dire conse-
quences when socket grafting itself is fairly predictable.
Now, you start talking about failures of 13- and 16-mm