The easy Açai !!!

Two weeks post-op, a phone call from France — and a diagnosis that didn’t add up.

Good morning everyone,

Good Friday — and we’re enjoying the beautiful Algarve sun. Fresh fish, nature, beach, and sunlight. Perfect to recharge for another three months of work.

The other day I had a fantastic case

.

A patient called us from Lille, France, saying her implant crown was moving. This was an immediate loading case on an upper premolar (tooth 14): immediate implant placement with immediate function, but without occlusal contact.

We had placed a TLX 3.75 x 10 NT with a polished collar — around 12 mm total length, including approximately 1.8 mm of polished collar coronally. Primary stability was excellent, with an ISQ of 72.

Two weeks later, she called saying the crown was moving. She was in Lille, and I advised her to see a local dentist. But no dentist in France wanted to touch the case — because they hadn’t done it. And once they knew I had placed the implant… even less.

She contacted the clinic. Liliana spoke to me, Margarida was there as well, and both immediately said:“It’s a failed implant.”

Because they were thinking about a similar case.

But in reality… it wasn’t similar at all.

Margarida’s case was an immediate implant on tooth 24 in a completely non-indicated situation. The only available bone was apical, and the implant actually perforated about 2 mm into the maxillary sinus cortical.

This is rare — because in most upper premolars we still have palatal bone, the so-called “magic triangle.” But in this case, there was essentially nothing.

Still, we went ahead.

A BLX 4.5 x 10 was placed with an ISQ between 44 and 47 — borderline stability. And despite that, we delivered immediate loading without occlusal contact. If we revisit ITI guidelines, it’s clear: this was a sequence of decisions outside ideal indication.

And to make things worse, the patient was a bruxer. High bite force, overload, poor control of maintenance, and diet.

Outcome? Failure.

So these were two completely different cases.

And I said immediately:“Careful — this is not the same situation.”

At two weeks, in Manon’s case, it is extremely unlikely for the implant to be lost from a biological standpoint. The implant is still transitioning from primary to secondary stability. Bone remodeling is not complete.

If we go back to the work of John Brunski and the principles of Per-Ingvar Brånemark, we understand the phases of osseointegration and how implants behave in different bone qualities (types I, II, III, and IV).

So… it didn’t add up.

Liliana and Margarida said:“We bet an açaí it’s a failed implant.”

And I said:“I’ll take that bet — but I want two açaís when I win.”

The only risk factor Manon had was aligners, which we had already carefully checked one week post-op, ensuring no occlusal contact and proper control.

We waited for her.

She arrived… with the crown in her hand.

Case solved.

The implant was stable. No pain, no mobility, radiographically intact.

The issue? Most likely contamination at the interface — small particles of regenerative material in the connection, leading to improper seating or mechanical interference.

Simple things… that look like big problems.

We cleaned the area with chlorhexidine, checked everything, and prepared for crown reinstallation.

The takeaway:

One case with perfect indication → success. One case full of compromised decisions → failure, but the diagnosis… that takes minutes

Two different cases.Same anxiety.Completely different outcomes.

In implant dentistry — like in life — not everything that moves is lost.

And very often…clinical reasoning wins the bet in less than 20 minutes.

Easy money. Easy açaí.

Happy Easter.