Broken Implant Fixture: What Do You Recommend?

Dr. T, In light of the questions you are asking- I would refer this patient to someone with a bit more experience than you. This is not a knock on your abilities, but reality. Removing a failed implant can be tough and can lead to a huge defect. If not handled correctly the results in the anterior esthetic zone can be devistating.

dr T please tell us more about size of fixture and length in which fixture broken

I am in agreement with Dr Schlesinger, it may be worth your while to refer out. A cone beam or volumetric tomography scan would be very helpfull. You or the next Dr would know how much bone is between the implant and the buccal plate. Figure in the thickness of the trephine drill - and decide if it can be done.

to my patients. if occours this damage. rather always i say that if titanium piece is well integrated and i don't need exactly that place for another implant . it will the best choice to let in that place the broken fragment.

I don't suppose there is a better way yet, to remove an osseointegrated implant from its site, than to explant it using a Trephine. In the Maxillary lateral region, it is highly likely that the Labial cortical plate is really thinned out after the removal (if it does in fact remain standing and is identifiable as an entity after the Explantation!!). This being the case, the residual deficit that would be left behind would be akin to an Extraction socket defect left behind after the removal of a lateral Incisor which had associated peri-odontal / peri-apical issues in the past (typically the RCTreated, Post-core restored, now failed and unsalvageable kind of situation). Only an autogenous (ideally use the same Trephine that you used to remove the Implant and get a core from the symphysis)block of bone would get the job done with aplomb! It would also assure excellent soft-tissue support around the next implant that you go back and place after the graft has healed. Cheers

Thank you for the recommendations. The size of the implant is a 4 mm diameter and a 13 mm length. It's position is in the canine region in the upper yaw and there isn't to much buccal bone since I inspect it. The head of the implant was broken and it is approximal 3 mm in length. Because the fixure kept the parts together with movement some bone loss already occur ( 3 mm) and gives inflammation to the gum. I think I am going to lose the buccal bone. But putting in a bone graft? The gum is inflamed too. I have learn to leave the site to heal first and worry about the build up later. What do the experts recommend?

If you are going to remove the implant Dr Aiyappa's advice is spot on. Soft-tissue inflammation will not affect the outcome of the graft. The tissues will be inflamed after you place the graft anyway! My practice is 100% implant referral so I've dealt with quite a few broken implants over the years. It is certainly the case that you will have a big defect to resolve after removal of a well-integrated implant. If it was related to a bridge (where anti-rotation is not an issue) I would look at taking a large tungsten-carbide bur and flattening the implant head. Depending on the implant type this usually only removes the anti-rotational feature (hex) and a new abutment, perhaps a long healing abutment, can be placed and prepped in the mouth. You might even consider that in this case, cementing the abutment in place and if you have group function keeping it clear of lateral excursions; there has likely been an occlusal or parafunction problem here anyway! Whats to lose but a small lab-bill? Good luck, John M

I have used piezosurgery to remove implants as atraumatically as possible. The advantage here is no excess heat to the bone as well as very contolled cutting. Trephines produce a lot of heat and associated necrosis of bone. With piezosurgery and an ultrafine tip, and patience, these sites can be salvaged. It will need a graft as it will leave a defect. I would refer this if I were you, but there is no harm in asking. I never try to place an implant into these sites immediately. One miracle at a time with implant surgery is a good guideline to follow.

Hi Jeevan couldn't agree with you more. trephining it out seems to be the best bet,but always followed by GBR and good soft tissue closure

Well I trephined the implant out and took my time with double irrigation to prevent heating the bone to much. It came out with not to much trouble. After this procedure I did some GBR, but the bone was allready destroyed quite a bit for the procedure leaving some treats above the bone. So I think I have to rebuild it with a bone block in the future anyway. Thanks for all the good help

Hello- Sorry, but I cannot recommend trephining of any implant anywhere, particularly in the maxillary anterior. Too much heat is generated, no matter how much you irrigate, and I've seen some absolutely horrific deformities, that can never really be repaired successfully. If you absolutely are convinced that you must trephine (shudder), then only trepine down 3-4 mm or so and then see if you can use a regular extraction forceps to work the implant loose. You'd be surprised how well this works. Recommendations: 1- Consider Piezo if surgical removal is the only realistic option. The blades are incredibly thin, and generate virtually no heat (which is death to bone and soft tissue) 2- If you're Piezo is your only realistic option, try to improvise a way to back the implant out first. You'd be surprised how often you can back out an implant that has "osseointegrated". If you chew up the implant no worries because you were going to Piezo it out anyway. If you are not completely comfortable with this I would refer this out, just make sure the person you refer it out to knows what he or she is doing ;) Ask questions and don't be allow yourself to be intimidated. We all started somewhere, afterall. 3 - A last option, that probably won't work in this case but has worked successfully in others, is to consider taking an impression of the internal aspect using any manner of post, and then have the lab fabricate a custom abutment that you'll then cement down into the implant. Not perfect, but it does work and is a realistic option in certain cases.

We found one alternative listed to piezo, trephine & diamonds. (We didn't get try it since we were removing old broken Core-Vents.)I don't have the article handy, but the technique used a brief touch from electrosurgery tip which heats and kills a narrow (10 - 100 um) band of bone around the implant. A week or two later, the implant supposedly unscrews right out. For what it's worth...

Hi Guys, I presented a high torque removal technique at the ADI meeting in London earlier this month. The days of using trephines, bone drills, chisels and thermo-necrosis are probably nearly over. The advantages of this over other techniques are (briefly, as follows;- 1. the technique preserves the bone that surrounds the implant. in the case of implant removal because of bad positioning, Retreatment is possible immediately. 2. I have removed fully integrated implants with minimal loss of bone. Typical bone loss is limited to the depths of the thread pattern. 3. The technique allows the retrieval of broken implants also. 4. typical removal is atraumatic and takes less than ten minutes. post-operative care is simple and minimal. For those who may be interested in learning more I can probably be tracked down online or through the Association of Dental Implantology in the UK. (I hesitate to add a contact due to the rules on posting). Rob

Robin, I left a message with the ADI for you to contact me directly. I saw an advertisement for the BTI implant removal system. It looks straight forward and atraumatic...is this similar to the system you mentioned? Thank you.