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Journal of Prosthetic Dentistry

Considerations and techniques for removal of osseointegrated implants

  • Akanksha Srivastava
    Correspondence
    Corresponding author: Dr Akanksha Srivastava, 811 S Paulina Street, Suite 161, Chicago, IL 60612
    Affiliations
    Assistant Professor, Division of Plastic Surgery, Department of Surgery, College of Medicine, University of Illinois at Chicago, Chicago, Ill

    Maxillofacial Prosthodontist, Craniofacial Center, University of Illinois Health, Chicago, Ill
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      Abstract

      Implant-supported restorations have become a successful, predictable, and mostly a first-choice strategy for replacement of missing teeth. However, complications such as implant fracture, malpositioned or poorly angled implants, and peri-implantitis persist in implant dentistry. Management of these complications may necessitate removal of an osseointegrated implant. Traditionally, implant removal has been a surgically invasive procedure; however, minimally invasive explantation techniques have evolved substantially over the last few years. This digital presentation describes various scenarios where osseointegrated implants require explantation, decision-making considerations, and techniques for removal of osseointegrated implants.

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      November 30, 2022

      Considerations and techniques for removal of osseointegrated implants

      Akanksha Srivastava, BDS, MSc, MDSc, FRCD(C)

      Summary

      Different scenarios necessitate early removal of a dental implant, including inferior alveolar nerve injury, surgical site infection that is not responsive to conservative management, and osseointegration failure.
      • Shavit I.
      • Juodzbalys G.
      Inferior alveolar nerve injuries following implant placement-importance of early diagnosis and treatment: a systematic review.
      • Chrcanovic B.R.
      • Kisch J.
      • Albrektsson T.
      • Wennerberg A.
      Factors influencing early dental implant failures.
      • Juodzbalys G.
      • Wang H.L.
      • Sabalys G.
      • Sidlauskas A.
      • Galindo-Moreno P.
      Inferior alveolar nerve injury associated with implant surgery.
      In all these situations implant removal is relatively straightforward because the implant is not osseointegrated. In contrast, an osseointegrated implant may need to be removed for several reasons.
      Implant fractures are relatively an uncommon complication
      • Goodacre C.J.
      • Bernal G.
      • Rungcharassaeng K.
      • Kan J.Y.
      Clinical complications with implants and implant prostheses.
      but can be a challenging situation in terms of removal of the fractured implant. In comparison, malpositioned or poorly angled implants are one of the more common complications.
      • Bidra A.S.
      Prosthodontic management of malpositioned implants and implant occlusion complications.
      Malpositioned implants can occasionally be restored with angled or custom abutments and angled screw channels. However, a severe malposition may prohibit the use of these prosthetic components because of their biomechanical limits and result in prosthetic and esthetic failures. In such situations, removal of the malpositioned implant should be considered rather than restoration of a severely compromised implant.
      • Bidra A.S.
      Prosthodontic management of malpositioned implants and implant occlusion complications.
      Similarly, peri-implantitis is a complex situation where the decision between adopting regenerative approaches as opposed to considering implant removal is not always straightforward. The extent of bone loss, predictability of regenerative treatments, and esthetic concerns are just a few of the many factors that need to be carefully assessed.
      • Tarnow D.P.
      • Chu S.J.
      • Fletcher P.D.
      Clinical decisions: determining when to save or remove an ailing implant.
      Additionally, individuals with failing dentition or implants placed previously for restoring partially edentulous spaces who are now planned for conversion to a complete-arch implant-supported prosthesis may require removal of osseointegrated implants.
      The decision-making process for removing an osseointegrated implant is always multifactorial.
      • Tarnow D.P.
      • Chu S.J.
      • Fletcher P.D.
      Clinical decisions: determining when to save or remove an ailing implant.
      Factors to consider commonly include esthetics, access, and predictability of alternative procedures, success of existing prosthesis, patient factors, financial considerations, history of radiation, antiresorptive or antiangiogenic therapy, and feasibility of implant removal using minimally invasive techniques.
      Techniques for implant removal can be broadly divided into reverse torque-based techniques and peri-implant bone removal techniques.
      • Tarnow D.P.
      • Chu S.J.
      • Fletcher P.D.
      Clinical decisions: determining when to save or remove an ailing implant.
      • Bowkett A.
      • Laverty D.
      • Patel A.
      • Addy L.
      Removal techniques for failed implants.
      • Froum S.
      • Yamanaka T.
      • Cho S.C.
      • Kelly R.
      • St James S.
      • Elian N.
      Techniques to remove a failed integrated implant.
      The latter include bone removal with piezosurgery, trephines, low- and high-speed burs, elevators, and forceps. This digital presentation reviews clinical treatments, clinical indications, advantages, and limitations of each of these techniques.

      Acknowledgments

      The author thanks Drs Avinash Bidra, Joe Lee, Mitchell J Persennaire, Michael Stangler, and Florian Kernen for their assistance with documentation and collaboration on patient treatments within this presentation.

      Supplementary Data

      References

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