Case Series on Management and Prevention of Displacement of Implants in Focal Osteoporotic Sites: Suggested Protocols and Guidelines

Implant displacement in focal osteoporotic sites of the posterior mandible is a surgical complication. The current case series addresses the management of displaced implants (through cases 1 and 2) and the prevention of implant displacement in focal osteoporotic sites using allogenic particulate graft in the osteotomy site (through cases 3 and 4). The case series highlights 4 aspects. The first pertains to careful assessment of the grayscale value of the pre-evaluation cone-beam computerized tomography. Second is to rely on tactile feedback during the use of the pilot drill for osteotomy preparation. Undersized drilling during sequential preparation is recommended if resistance is absent during osteotomy. Third, it is recommended to use an implant design, such as a tapered or parallel tapered implant system with coronal microthreads and to avoid designs with crestal taper. Fourth is surgical modification by using particulate allogenic graft to obturate the osteotomy. The implant may be placed immediately after graft obturation or after new bone formation, depending on the thickness of the cortical bone at the crest. The premise of the technique is that the allogenic bone graft in the osteotomy provides an environment that promotes an osteogenic potential through contact osteogenesis. The consolidated graft material also provides a physical bed for the implant, thereby minimizing implant displacement.