Fractured implant: Remove or bury?
This is a case that came into my office recently. The implant in question is fractured, causing the abutment and crown to be dislodged. You can see the distal aspect of the occlusal platform bulges out and this implant will no longer support an abutment or screw. The healing abutment that I placed will also not stay on, so the question is what would you do now? The patient does not want another implant in this area and thinks a fixed bridge might be his best option, but would you remove the implant? Let it “sleep”? What about that pesky sinus sitting above the implant? What do you recommend?
18 Comments on Fractured implant: Remove or bury?
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A.Eid DDS
6/8/2017
You remove the Implant,Bone Graft the area
3 months go ahead with the 3 units
Implant guy
6/8/2017
What kind of implant is that? Remove the implant salvin makes a nice implant removal kit and start over
Zahir khokhar
6/8/2017
Remove, graft, replace
Fereydoon
6/8/2017
Definitely you have to remove implant.it causes sever bone resorption.At least 10 patients with fractured implants came to our department.all of them happened in a narrow implant with the regular abutment.
Dr Amit Duggal
6/8/2017
Definitely remove using an implant removal kit, graft if required and then reassess for implant or bridge discussing pros and cons of each.
Merlin Ohmer
6/8/2017
When in doubt, take it out. Best long-term solution is to remove implant and graft. Cross the restorative bridge when you get to it.
Dr Amit Duggal
6/8/2017
Also assess mouth for signs of parafunction. If so provide a Michigan splint / protective mouthguard. Best of luck.
José manuel
6/8/2017
Since the fracture is at the platform level, where most removal kits need to do the job, I think you should remove it using a trephine with the smallest diameter according to the implant, then graft and if everything goes right, explain the patient that an implant is still a best option
Good luck
DrT
6/8/2017
The anterior abutment is a virgin tooth. Please do not cut away all that perfectly healthy enamel. Give the patient the options of 1) do nothing, 2) RPD, 3) implant.
Remember; First do no harm!
Sean
6/8/2017
Great comments and thank you for the feedback. It would seem like an obvious choice to remove, graft and re-evaluate for new implant or fixed case. However, removal of the implant will require significant bone removal and likely sinus involvement. If the healing cap is removed, keratinized tissue forms over the implant would it be that risky to leave it in place and preserve the bone that is there now? I appreciate your insight.
Sam
6/8/2017
If you for any reason absolutely will not do a new implant then you can grind the cervical part of the implant so the remaining part of the implant is submerged then the implant will be buried and the bone will cover it. It can always be removed in future.
Good luck
Timothy Hacker DDS, FAAID
6/8/2017
I have personally seen these internal hex implants fracture like this. This is usually from over tightening the abutment screw or healing abutment; as the internal limit for the screw depth does not provide a stop. It's sad that these implant platforms flake off like the petals of a flower and give you no choice but to remove an integrated titanium fixture. If you polish the platform and leave it the patient will always have a little drainage tract over the implant platform where bacterial film stays and you will eventually witness bone loss there. The good news is that the removed bone will grow back and a different brand of implant is still the best choice for a predictable definitive restoration.
ANISH GOYAL
6/8/2017
How about using electrocautery for implant removal which saves bone as compared to trephines. But sinus is right there, don't know whether it's a good choice. Any comments on use of electrocautery and its effects on bone.
Emad Hanbali
6/9/2017
It is wise to to determine the cause of the incident and to contact the implant company for more discussion.
The broken implant should be removed, removal of the implant carries the risk of sinus involvement and bone lose around it and this should be explained to the patient.
What are the causes for the patient's decision not to have a new implant ? . Usually patients treated with dental implant do not accept an alternative ?
Good luck
Sean R
6/9/2017
It was a Zimmer implant. Placed several years ago at a dental school and I believe the cause of fracture was two issues. The restoration was not aligned with the implant causing excessive lateral force and the crown to root ratio was close to 2:1. I did contact the implant company and they would not replace the implant, in part because of the length of time.
As with many patients, the initial placement took a long time and the patient did not want to undergo more surgery and more time.
Thanks for the comments and suggestions!
Charles
6/9/2017
Remove the implant and graft-assess molars periodontal state....r-graphically appears with significant distal bone loss and possibly gr II/III furcation involvement.
If confirmed ext molar and graft. Re-eval site in 3-4months for sinus graft and the placement of 2-3 implants splinted per opposing dentition and paraf(x). In my opinion a 4 unit fpd is rarely an adequate tx option especially on a canine-otherwise romove implant and leave it.
Hassan
6/9/2017
Hi
If patient can accept an other implant, (even after years), remove and graft
If patient refuse an other implant, just covet it and bridge or not bridge
Before removing the implant, try to use it and cut it like a root with cemented abutment and crown, I did it several times, it works...
CRS
6/11/2017
Remove it graft, it is an important site, the molar is iffy.
