After vitamin D supplementation and a healing period of 6 months, a third surgical intervention was planned and one implant (Conelog ScrewLine) was inserted in region 36 (see Table 1 and Fig. 1d). During implant placement, the former explantation site appeared clinically fully re-ossified. The patient received an intraoperative intravenous single-dose antibiotic therapy with Isocillin 1.2 mega. At this time point, the patient demonstrated a vitamin D level of 46 μg/l. Second-stage surgery was successfully performed and the prosthetic restoration initiated. For all implants, a primary stability had been achieved.

Patient

In this 51-year-old male patient, no grafting procedure was performed as vertical and horizontal alveolar ridge dimension was adequate for implant placement. The implant placement in regions 36 and 37 was performed as guided surgery (Fig. 2a, Table 1). The implant placement was uneventful and the bone appeared clinically healthy. A cortical bone profiling was performed during implant placement. One day postoperatively, the patient reported of a discomfort in the area of the operation but not severe pain. On day 7 postoperatively during a routine examination, the patient complained of continuous increasing severe pain since the operation. A medicinal pain therapy (ibuprofen 600 mg) was ineffective so that an explantation of both implants was performed at day 15. The serum vitamin D level showed an incipient deficiency (serum vitamin D level 20 μg/l). After vitamin D supplementation, a second implant placement in region 37 was performed successfully 4 months later. In region 36, a bony defect filled with granulation tissue was discovered and a debridement performed. Implant placement in region 36 was performed 8 weeks after the debridement (6 months after the first implant placement) (see Fig. 2b). The follow-up of both implants was uneventful and the prosthetic restoration performed. For all implants, a primary stability has been achieved. In both patients, appropriate torque was achieved using the system specific torque meter. After detailed vitamin D anamnesis malnutrition and insufficient sun exposure could be excluded as cause for vitamin D deficiency in both patients.