Best Method to Remove Osseotite Implant?

If you would want to remove ANY osseointegrated implant (ie. ITI, Nobel, Astra, Zimmer) you will most likely need to trephine it out.

There is no easy way. You have a 4 mm platform. Maybe you could use a custom abutment on the existing implant instead of trying for a wider one. Wider is not always better. 18 mm long, wow. It is certainly strong enough for almost anything. You must have a serious, unsolvable, esthetic problem to consider its removal. There will be a lot of bone loss to remove it with a trephine burr. You have to trephine all the way to the apex and then break it out. If you decide to do this, don't forget to keep the bone cool, while working. That is difficult with a trephine burr. Its a tough job and you will probably need to graft the area and wait before placing a new, wider implant. Avoid this if at all possible. Best of luck.

Why on earth would you want to remove an 18 mm long integrated implant just to place a wider one? Is there a problem with it?Emergence profile can be developed with a custom abutment. Removal of implants that are integrated is very difficult and time consuming.

If you have to remove it due to the implant being non-restorable or whatever reason----you've decided it must be removed.....you have several options. Piezosurgery is helpful to minimize bone defects caused by trephines. Trephines work, usually 1/2 to 2/3 the length of the implant, then it can be reversed torqued and removed. The problem comes into play when the width of the ridge is close to the width of implant. Trephine use there may leave a significant 2walled, 1 walled or 0 walled defect depending on the damage it takes to retrieve an implant. 18mm seems a tad long but I've found a much better way to retrieve implants. There is a surgeon I learned this from (USC, Bac Le) and he advocates the use of cautery and delayed recovery. He sets the cautery unit to 30-40 joules and applies it directly to the head of the implant for about 30 seconds. The implant conducts the current and heats the surrounding bone. This causes roughly 1/4 to 1/2mm of bone necrosis around the implant. You return in 7-10 days and back out the implant with a torque of 25-30 ncm. Although I don't remove many implants, I do see patients who get implants placed south of the border to save money. Occasionally they see me to "fix" the problem once their restorative doc has thrown in the towel. Most of the time, the implants are so out of position, there is no other restorative solution except to remove the implant. I've used this technique on a whopping 3 cases and it worked very well with far less collateral injury to the bone than trephine recovery. The coronal soft tissue will be boggy for about two weeks, but recovers nicely. It is a nice technique and when evaluating any retrieval technique I ask myself what could be the worst case scenario. Certainly the "U" shaped deformity due to a total loss of the buccal and palatal plate in the anterior is much more difficult to repair than up to a 1/2 mm of necrotic bone from cautery use. The technique I use is get the patient numb, set the cautery unit (coagulation--partially rectified) to between 30-40 joules, then I use it in 3 separate 10 second bursts on the implant (with 10 second breaks). I put a healing collar on (so I don't have to open the patient again next time--but it is not necessary). 7 to 10 days later, place a transfer mount on the implant after the patient is numb, and back it out. You can then curette the walls to get good bleeding bone and graft if you wish.

One other point, even though the walls look ok after curetting, don't place a wider implant at that time as the bone will still be going through ending phase I and phase II bone healing. This technique, future implants must be delayed. Bruce Bohannan

The company that sells you the implant also provides for kits for it's removal. most good companies have good foresight . Contact your Osseotite salesman.

Never never use electrosurg on in implant for removal. It is crazy and dangerous....no matter how successful someone else has been using it. You can loose all the bone and devastate the patient and your pocketbook. I patient I know of lost the anterior mandible.......

To quote the legendary Morton Amsterdam, “You always have time to do it right the second time.” So we have an implant that needs to be removed for some reason. I assume that you plan on placing another implant at some time. That being said, are we (you) doing this as an exercise or are we looking to do everything in our cannon to make sure that we get it right the second time? I recommend that we approach this procedure as a regenerative process. Design and reflect your flap accordingly. Once the implant has been removed, graft the socket/site and use a membrane. Allow it to heal with as much bone as you can gain and then place the implant in the best possible position. I carefully use a small round bur and cut at the junction of the implant and bone minimizing the excessive removal of bone. As we go down the fixture I will try to reverse torque with minimal force. The one thing I don’t want to due is damage the socket. As long as there are 3 sides, regeneration is all but a given.

Osseotite is an acid etched smooth surface that will unscrew from bone relatively easily. Buy the implant removal tool I developed in the mid-1990's and now sold by Zimmer Dental. It is a pointed threaded tool with the threads in reverse. When you insert it in the internal threads of the implant and turn counter-clockwise, the tool locks on to the internal threads and will put a reverse torque on the implant unscrewing it. An osseointegrated titanium implant will unscrew from bone, leaving mature threads in the bone. You could screw another implant into the site if it is the same thread pattern or you could resize the socket and screw in a wider diameter implant.

Why are you removing the 4.0 implant? How wide of an implant are you planning on placing? If the implant is integrated is this a position problem? 3i has a variety of abutments that can be adapated to work. I would not even think about removing a 18 mm implant unless it is in the wrong position or if it has not integrated properly. You will destroy a significant amount of bone to remove it with a trephine.

FYI: to those who may not know it: Piezosurgery, is not an electrosurgery unit.

I think Bayarea and Niznick's ideas are great. Niznick is very experienced and try his method first. If it does not budge you can just use a long shank diamond bur for crown prep and cut a slot into the bone as close to the implant , ''damaging" the bone to create remodelling and try Niznick's technique. The bone will give thus facilitating the removal. If you are brave like Bayarea then give his electrocaut a try. It sure will work. Just follow his power setting and dont overcook the bone. Spray water using the air and water syringe as and insurance. Don't have to use the piezo or trephine. They are sophisticated marketing. If you want that try the NDYag laser and hit the implant like the electro. How's that for high tech and sophisticated marketing. All the best to you D.

Dear sirs, I honor Dr. Bayarea with my deepest respects, but for those colleagues who actually think that electrocauterization is originally HIS technique, I humbly ask them to follow the link below http://www.osseonews.com/best-technique-for-removing-osseointegrated-implants/ (comment No. 10), or refer them to the British Dental Journal, 1st issue(January) 2008, a letter to the editor: No Need For Grafting.Thank you.