Best techniques for removing implants?
I need to remove some implants that have varying degrees of bone loss and are: 1. Integrated with poor prosthetic placement. 2. Failing with peri-implantits but still solid. 3. Flowered with peri-implantitis near v3 nerve. I do not want to cause damage to the surrounding hard or soft tissue. I plan on removing the implants and then grafting the defects as appropriate. I have used trephines in the past to remove osseointegrated implants. I have not had to remove many of these and I have had experience in removing failing sub-periosteal impants and blade implants as an oral maxillofacial surgeon. I would like the expertise and finesse of my implant colleagues to add to my surgical toolbox and to learn from those with more experience.
10 Comments on Best techniques for removing implants?
New comments are currently closed for this post.
Peter Fairbairn
6/28/2013
Must be the Neo Biotech fixture removal kit . A bit scary when the integration breaks at about 250-300 Nm but great for the job.
Clean , quick and safe
Baker Vinci
7/2/2013
I have never used the reverse torque system, but have found that each implant requires a different technique. Nothing replaces the accumulated knowledge of removing ankylosed teeth. I have used trephines, slightly bigger than the implant and in my opinion that is the " safest " way to remove the refractory fixture. Bvinci
Dr. Gerald Rudick
7/2/2013
A couple of years ago, I had to remove a Calcitek implant that had been in the mouth 20 years. Calcitek was famous for its HA coating, and the implants were straight cylinders, no threads..... they were pressed into place.
The problem was that just as the HA coating was thought to attract bone cells, it was also attractive to dental plaque, and hence would cause peri-implantitis.
These implants were flat top cylinders, wit no internal or external hexes to grip on to, so the only way I could manage to alleviate the problem, was to literally grind up the implant with an elongated round carbide bur with copious irrigation....... but the bur did not reach the depth of the entire implant....so I ground out what I could, left the rest, and placed grafting material into the hole I created..... the hole filled in with dense bone, and the problem went away.....but I certainly could not use that area of the jaw to place a new implant.
Dr. Gerry Rudick Montreal, Canada
Peter Hunt
7/3/2013
Trephines tend to leave large deficiencies in the bone which can cause major problems. You also have to be careful about cooling....it can be easy to overheat the bone.
In many cases it is easiest to cut out a buccal window using an ultrasonic, then tap the implant from the lingual. It's really quite simple and leaves a nice site for a new implant, all that is then necessary is to augment for the missing buccal wall.
So instead of leaving a failing implant, a better one can be placed and bought back into function quite quickly. There is a good case of this on CamlogConnect.com in the Tips section by Dr Gert de Lange from the Netherlands.
Baker Vinci
7/4/2013
Peter, I would be reluctant to sacrifice the buccal wall, unless absolutely necessary."It" is the single most important hard tissue variable we have, when placing implants. You should cool all cutting devices. High speed 100,000 and 50,000 k trephines are more likely to burn bone, so I encourage using the one that goes with the implant hand piece. B Vinci
drphunt
7/5/2013
Actually, you do not necessarily need to sacrifice the buccal wall. If you are using an ultrasonic device the "cuts" can be so small that the buccal wall can be removed intact and then replaced around the new implant. The critical thing is to augment over the region and to use a membrane over the augmentation material.
I was nervous about this concept at first, but now find it remarkably simple, safe and predictable.
Baker Vinci
7/5/2013
I'm not nervous about removing the buccal wall, I just refuse to. If you remove it intact and attempt to reposition it, you are performing a block graft, with a poor nutrient supply. I have done way too many block grafts, to create the defect. Just my preference. I just er to the lingual, with a small round bur or trephine. Bvinci
CRS
7/3/2013
Thank you gentlemen these tips coming from very experienced clinicians as you are, very much appreciated! I am the poster.
Constantinos Mantalenakis
7/7/2013
I am using the reverse torque with special instumentation for al kind of implants (internal -external connection , cylinders like IMZ ) with great succes leaving intact bony walls with reverse torque reaching 200 Nt . If more torque needed use trephine for the first 3mm and then you can easily remove the implant.
Then depending on the case or you graft or you insert a new implant.
Constantinos Mantalenakis
Richard Hughes, DDS, FAAI
7/8/2013
I have only removed a very small number of implants. I grabbed the top of the implant with extraction forceps and reversed torqued (muscled them out). This was prior to new instrumentation. No heat was generated and not that uncomfortable for the patient.
I don't like doing removing implants but sometimes it has to be done.
