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.
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.
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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
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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.5
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.5
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.
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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.
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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.
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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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© 2022 by the Editorial Council for The Journal of Prosthetic Dentistry.
