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.

This article demonstrated that implant placement was successful after vitamin D supplementation in patients with vitamin D deficiency and early failed implants. None of the patients showed systemic disease or did take regular medication, alcohol, nicotine, or drugs. The patients were not immunosuppressed, irradiated, or received chemotherapy. All implants were inserted with the same recommended torque of <35 Ncm. Bone overheat or compression due to implant preparation/placement or contamination of implants surface during the surgical procedure were excluded due to a sufficient irrigation and the surgical protocol. In the end, only common obvious deficit of both patients was vitamin D deficiency. The blood analysis was otherwise unsuspicious. However, in the first patient, implants were placed 3 months after vertical autogenous bone augmentation with no systemic antibiotic treatment while antibiotics were given during the third successful attempt several months after guided bone regeneration. Missing antibiotic treatment and the grafting procedures have to be considered as conceivable factors for the early implant failure in the present patients nonetheless [10, 11]. To date, a vitamin D screening before implant placement has not become standard in our clinic; but in patients with early implant failure, a vitamin D screening is initiated.