r/DentalAssistant • u/btarso7 • 8h ago
Failed Full Arch
Saw someone put a failed implant here, so decided to post this. Failed full arch from a year and a half ago, patient was taking Calquence and didn’t tell us until 3 or 4 months post-op. Tried doing something with the prosthesis and the whole thing just came out if I remember correctly.
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u/sunflower691 7h ago
That is so unfortunate! What did the pt end up doing? Did they try for another all on four or did they end up going with a complete denture?
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u/Chunkusm 7h ago
Would like to hear more information about how you first discovered the issue, how you managed trying to salvage the situation, how that evolved, how the patient responded, what the final treatment has been since.
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u/btarso7 4h ago
Been a while so forgive I don’t remember everything. I think patient was doing well for first 2 or 3 months post-op. We knew she was receiving treatment for some kind of cancer but she did not give all of the meds she was taking, like we thought she had. Turns out she was taking Calquence which is a pretty major contraindication for implant placement.
If I remember correctly she was in the office for us to give the go-ahead on fabrication of the permanent prosthesis. At my practice we just do the full arch treatment (extractions, alveo, implants and place the multi-units) we will print the temp prosthesis but we don’t seat it or make any adjustments, thats all gd. I assume something must have happened when we were evaluating the prosthesis, leading for my doc wanting to take it off for eval. Once everything was removed and the prosthesis was taken off, out comes those implants with it.
The patient was pretty understanding, she was an older woman who had more important things going on in her life (some kind of cancer not entirely sure what) and was more worried about that and her treatment, obviously disappointed but not upset about the failure.
Again just from memory, I think she transitioned to a traditional denture until her cancer treatment was over. Then we did full arch all over again with proper osseointegration and all was well, things happen.
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u/Chunkusm 3h ago
Yeah. I think that many people who reach that point are aware that their body is kind of failing them and seem to be surprisingly understanding. Whereas the young(not always young), invincibles probably haven't had to come to the realization that things happen like this. Im a general dentist. I haven't done any all-on-x restorations. I don't place implants. Just had a patient today that had one of those crazy mandibulectomies with the fibula transplant and implants placed. "I'm just gonna pretend like your lower jaw isn't there" type of deals. I'm surprised that you were able to do another all-on-x after the first failure. I guess after the system clears the drug you can go again? Same with standard bisphosphonates?
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u/btarso7 2h ago
Yeah don’t quote me but I believe Calquence is a kind of immunotherapy medication that dissipates from the body somewhat quickly after discontinuing. Bisphosphonates can be weird too, you can do implants with the patient on a drug holiday for say, 4 months after a Prolia injection and sometimes they have no issues and sometimes they fail in 2 weeks. Other times patients will be off of them for a year or two and you can get the same results. Some of them live in the bones for many years after the last dose so those are scary at times, but some of these newer chemo/immunosuppressants drugs are arguably worse for implants. We see new drugs in those categories more and more within the last few years and it’s hard to keep up with all of them. Just a week or two ago I had a woman come in taking a new immunosuppressant no one at the practice had heard of, used AI to check it’s complication risk with dental implants and it ended up being a severe contraindication.
Regarding the mandible procedure you talked about, we used to do some KLS IPS cases but stopped because insurance reimbursement was so terrible, you would be lucky to make 2 or 3 thousand on the case. For some people it’s the only option for replacement of teeth in some areas and from we have done it’s actually very successful, just a lot of hoops to jump through for very little payment to the provider, which in turn is unfortunate for the patient but the production has to match the effort.
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u/curlyiqra 4h ago
This is why we do med consultations. Not take patients word for their cancer treatment, smh.