Understanding the Failure

Understanding the Failure

October 2025 – Lisbon

Good morning, everyone.

It’s a wonderful autumn day in Lisbon. I’ve just dropped the kids at school and I’m heading to our new clinic on Alexandre Herculano Street. But as I drive through the city, I can’t help thinking that yesterday wasn’t one of our best days.

Truth is, we haven’t been having great days lately. Not terrible — just those slow, quiet weeks when implant cases are fewer and the universe seems to be whispering: “Reflect.”

Yesterday’s reflection came with a patient — a man around 60, healthy but a heavy smoker. One of those characters who claim they’re broke yet drive a Mercedes and carry the latest iPhone. He came to me saying,

R

“André, my daughter knows yours — she told me you’re a good implantologist. I need you to fix this mess.”

When I first saw him, he was missing two mandibular molars. Budget was tight, so I told him we could start with one molar — one solid unit is often enough for mastication, and we could always add the second later.

So I placed an 8.5 × 4 mm Biomet 3i implant, restored after two months with a monolithic ceramic crown.

That was mistake number one: the bone was D1-type, dense and unforgiving. I probably over-torqued the implant. It integrated, yes, but it was already a warning sign.

Mistake number two came later — the implant position. Not aligned to the Wilson curve, not even ideal mesiodistally. It worked, but it wasn’t beautiful.

Four years went by. The implant functioned fine until one day he returned with pain. On the radiograph, I saw a classic pattern of bone loss — not the deep crater type described by Isidor, but a detachment-like bone resorption, likely from occlusal trauma.

Here came mistake number three: instead of removing the implant, I decided to “balance” it by placing a posterior one (tooth 37). I thought: “It’s still stable; no need to remove it.” — Wrong.

Worse, I didn’t remove the crown of #36. Overconfidence made me think I could angle the new implant perfectly without disturbing the old one. Result? A buccally positioned implant, outside the keratinized zone. It integrated, yes — but poorly positioned prosthetically.

Now I had two crowns under occlusal trauma instead of one. Within a week of loading, the second implant began failing. Two failures instead of one.

That was the moment to stop.

I decided to remove everything and start again — properly this time.

After four months of healing, I returned with a fresh plan:

• #36: 3.75 mm implant, aligned to the Wilson curve, low-speed osteotomy, perfect irrigation. Torque 30 Ncm, ISQ 80.

• #37: 4.5 mm Straumann TLX Standard Plus — slightly angulated, correct tissue support, and a two-unit bridge for better load distribution.

This time, I respected biology. I respected the time.

What did I learn?

That dense bone hides traps. That “good enough” positioning isn’t good enough. That even 20 years of surgery don’t grant immunity from arrogance.

Sometimes, the real skill isn’t in drilling — it’s in admitting the mistake and starting again.

So today, as I walk to the clinic under this Lisbon light, I remind myself:

Failures are not scars of shame — they’re signposts on the map of mastery.

And this case, with all its mistakes, may end up being one of my best teachers.

When I walked out of the operatory yesterday, the suction stopped, the light went off, and I could still hear the echo of the handpiece in my head — not as a sound, but as a lesson.

You see, the handpiece has a rhythm. Some days it sings in perfect harmony with your hands. Other days it hums in dissonance, forcing you to listen, to slow down, to understand the failure.

That’s the real art of dentistry — not avoiding mistakes, but learning how to transform them into music again.