Introduction

Dental implants are a widely used treatment option for replacing missing teeth and restoring chewing function. They provide support for a fixed replacement tooth and can help patients regain comfort and confidence while eating and speaking. However, implant treatment involves a biological healing process, and in some cases, an implant may not successfully integrate with the surrounding jawbone.

At Summirow Dental Hospital, we treated a 68-year-old male patient who presented with a retained root piece in the lower-left back tooth region. After clinical evaluation, extraction and dental implant treatment were planned. Although the first implant did not achieve successful osseointegration, the case was carefully reassessed, and a second implant was placed at a different position. After three months of healing, the replacement implant demonstrated successful integration, and a screw-retained implant crown was delivered.

This case highlights the importance of proper evaluation, patient communication, and a well-planned approach when managing an implant that fails to integrate with the bone.

Patient Details and Chief Complaint

A 68-year-old male patient visited Summirow Dental Hospital with a retained root piece in the lower-left posterior region of the mouth.

The patient required treatment to address the compromised tooth and restore the missing tooth structure. Following clinical examination, dental implant treatment was considered an appropriate option for replacing the affected tooth, depending on the condition of the surrounding bone and tissues.

Chief concern: Retained root piece in the lower-left back tooth region.

Treatment planned: Extraction of the remaining root followed by dental implant placement and a final implant-supported crown.

Clinical Examination and Treatment Planning

The first step was to evaluate the affected area and determine the appropriate treatment approach. A retained root may be unsuitable for long-term preservation depending on its structural condition, associated infection, and remaining tooth structure.

After examination, extraction of the root piece was advised. Dental implant treatment was planned to replace the tooth and restore the patient's chewing function.

Implant planning requires careful assessment of the available bone, surrounding anatomical structures, gum health, and the patient's general medical history. The objective is to identify a suitable implant position that provides adequate support for the future crown.

The treatment plan was explained to the patient, including the expected healing period and the need for follow-up appointments before the final crown could be placed.

Step 1: Extraction of the Retained Root

The compromised root piece in the lower-left posterior region was extracted as part of the treatment plan.

Following extraction, the area was managed according to the clinical requirements to support healing and prepare for implant treatment. The timing of implant placement depends on the condition of the extraction site, bone availability, and the presence or absence of infection.

Once the site was considered suitable, the patient proceeded with dental implant placement.

Step 2: First Dental Implant Placement

The first dental implant was placed in the planned region to provide support for the replacement tooth.

After implant placement, a healing period was necessary to allow the surrounding bone to form a stable connection with the implant surface. This biological process is known as osseointegration.

Osseointegration is essential because the implant must achieve sufficient stability within the jawbone before it can safely support the final crown during chewing.

The patient was advised to attend follow-up appointments and allow adequate time for healing. The implant was monitored during the subsequent three-month period.

Step 3: Assessment After Three Months - Initial Implant Failure

At the three-month follow-up, the first implant had not successfully integrated with the surrounding bone.

Successful osseointegration is necessary for an implant to remain stable and support a functional restoration. When this biological connection does not develop adequately, the implant may remain unstable and cannot be predictably restored with a permanent crown.

This situation is known as early dental implant failure due to lack of osseointegration. It is a recognised complication of implant treatment and can occur even when the treatment plan initially appears suitable.

Implant failure can be associated with several factors, including local bone conditions, inadequate stability during healing, infection, excessive movement during the healing period, or individual healing factors. The exact cause cannot be established without a detailed clinical assessment.

In this patient's case, the initial implant did not integrate successfully within the expected healing period. 

Therefore, proceeding directly to crown placement was not appropriate.The priority was to reassess the area and plan the next stage of treatment carefully.

Step 4: Reassessment and Repeat Implant Placement

Following the initial implant failure, the treatment approach was revised.

Instead of repeating the implant placement at the same position, a second implant was placed at a different position after reassessing the site and its suitability.

The position of a dental implant is important because it must provide adequate bone support and allow the future crown to be designed with appropriate function and accessibility for cleaning.

The revised treatment plan aimed to provide a more suitable foundation for the replacement tooth while allowing the surrounding tissues to heal.

The patient was informed about the revised approach and the importance of allowing sufficient healing time before proceeding with the permanent restoration.

Step 5: Three Months of Healing After the Second Implant

Following the second implant placement, the patient was monitored during the healing period.

Over the next three months, the implant was allowed to heal without premature loading. Follow-up assessment was important to evaluate the stability of the implant and determine whether the surrounding bone had integrated adequately.

At the end of the three-month period, the second implant demonstrated successful integration with the surrounding bone, according to the clinical assessment.

This was an important milestone in the treatment because a stable implant foundation was necessary before the final crown could be delivered.

The successful healing allowed the treatment to progress to the restorative stage.

Step 6: Screw-Retained Implant Crown Placement

After confirming successful integration of the second implant, the final restoration was planned.

An implant-supported crown was fabricated to replace the missing lower-left posterior tooth. The crown was secured using a screw-retained attachment, which connects the crown to the implant through a prosthetic screw.

Screw-retained crowns offer several practical advantages when appropriately selected:

Secure attachment: The crown is connected directly to the implant restoration components.

Retrievability: The crown can generally be removed by the dentist when maintenance or repair is required.

No cement residue around the implant: Because the restoration is screw-retained, cement is not required to secure the crown.

Functional rehabilitation: The crown restores the tooth's shape and provides a chewing surface designed to work with the opposing teeth.

During crown delivery, the fit, contact with adjacent teeth, and bite were checked and adjusted as required. The aim was to provide a stable, comfortable restoration that could function effectively during daily activities.

Final Outcome

The patient completed the treatment with a screw-retained implant crown supported by the second implant.

Although the initial implant did not integrate successfully, reassessment and repeat implant placement at a different position resulted in a successful clinical outcome after three months of healing.

The patient was happy with the final restoration.

This case demonstrates that an unsuccessful first attempt does not necessarily mean implant treatment cannot be completed successfully. However, the decision to replace a failed implant must be based on the condition of the site, the patient's individual circumstances, and a revised treatment plan.

Why Is Osseointegration Important in Dental Implant Treatment?

Osseointegration is the process through which the jawbone forms a stable connection with the surface of a dental implant. It allows the implant to function as an artificial tooth root.

Without adequate integration, the implant may not have sufficient stability to withstand chewing forces. For this reason, the dentist evaluates the implant's healing and stability before proceeding with the permanent crown.

The healing period varies between patients and depends on factors such as bone quality, implant stability, surgical conditions, general health, and the treatment site.

In this case, the first implant did not integrate, whereas the second implant achieved successful integration following the revised treatment approach.

The Importance of Follow-Up After Implant Placement

Regular follow-up appointments are an essential part of implant treatment. They allow the dental team to monitor healing, evaluate implant stability, identify potential complications, and determine the appropriate time for crown placement.

Patients should also maintain good oral hygiene and attend regular professional check-ups after receiving their final implant crown.

Long-term implant maintenance includes:

  • Brushing twice daily with a soft-bristled toothbrush.
  • Cleaning carefully around the implant crown and gumline.
  • Using interdental cleaning aids recommended by the dentist.
  • Attending regular dental check-ups and professional cleaning appointments.
  • Avoiding smoking and following individual medical and post-operative advice.
  • Contacting the dentist if the crown feels loose or if pain, swelling, bleeding, or discomfort develops.

These measures help maintain the health of the surrounding gums and bone and support the long-term function of the implant restoration.

Conclusion

This 68-year-old male patient's case at Summirow Dental Hospital involved the management of a retained root in the lower-left posterior region, followed by dental implant treatment.

The first implant failed to achieve osseointegration after three months. Following reassessment, a second implant was placed at a different position. After another three months of healing, the replacement implant integrated successfully, and a screw-retained implant crown was delivered.

The patient was satisfied with the final result.

The key learning from this case is that careful reassessment, appropriate treatment planning, and regular follow-up are important when managing implant complications. Every implant case is different, and treatment decisions should be based on individual clinical findings rather than a fixed approach.