Larger or Smaller Diameter Dental Implant


K. F. Chow BDS., FDSRCS May 27th, 2010
The primary cause of the failure could be systemic or local. The patient is middle aged, with high BP and high cholesterol, hopefully controlled. Check the patient for diabetes and treat if necessary.
Dues should be paid to Dr Vaziri for highlighting the possible local causes like residual infection left behind by the endodontically treated tooth and the possibly low blood supply to the periodontium of such teeth that may prevent proper osseointegration.
Having said that, Carlos Boudet gave a very reasonable and workable local treatment response to the problem. But the possible systemic causes should be looked at first.
Lastly, a larger diameter implant is an absolute no no.
Besides all the eloquent reasons given earlier by the learned dentists not to do so, I would like to add one more.
Every dental implant we place also comes with a periodontal pocket….yes a pathology…. an iatrogenic condition. Bone will forms a biologic bond with titanium but the gums do not. What we have is a far cry from the sophisticated gingival cuff around a real tooth with the epithelial attachment and a well planned organisation of different types of fibres all designed to prevent infection from penetrating the emergent margin of the tooth.
If we have to make a perio pocket everytime we place and implant, it makes good sense to make a small diameter pocket rather than a larger diameter pocket that comes with a larger diameter implant. If we have to make a hole in the gums, make a small one as far as possible…. a smaller diameter ….not a larger diameter.
Cheers.

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