Removing cracked implants: suggestions?

I had this happen twice. If you have Piezotome, you can work around the implant, and then use regular elevator and remove the implant as you do normal extraction. Or you can use surgical handpiece with water irrigation and create space mesial or distal side of the implant, and again use regular elevator from the opposite side you created the space and take the implant out as you do your normal extraction.

The classic method is to trephine down around the implant with a trephine that is just slightly larger than the implant. However, there are two main concerns with this protocol. First, that it is difficult to cool the trephine as it goes down deeper, leading to overheating of the bone. Second, that this leaves a wider channel making it difficult to place a replacement implant at the same time. It is often better to use PiezoSurgical instrumentation for working down around the outside of the implant as this causes less heating and complications. A very simple procedure for implant removal is to raise a labial flap, then make two vertical Piezo saw cuts directly over the facial of the implant. The labial bone between the saw cuts can then be removed and the implant "Tapped out to the labial". This leaves the bone channel intact except for the labial region. A new implant can then be placed and the outer region can be regenerated. If the labial bone section that was removed is intact, then it can be replaced and used in the regeneration process. This procedure is particularly useful when the implant is close to adjacent teeth or other implants.

Much less agressive than a trephine (why waste any more bone that you have to regenerate) or a peiezo unit ( expensive toy, expensive tips) ....use a 701 and remove most of the buccal plate and tunnel mesially and distally to get purchase for an elevator. The buccal plate is EZ to regenerate at that same surgery. Does she have teeth distal to the implants? IF not than occlusal overload is the issue.

My question would be assuming you are able to remove the implants and regenerate the bone, what implants would you use to replace #4 and #5? Do you have enough ridge width to place 4.2mm diameter implants? This may help to reduce a repeat. Do you have any images of the site?

Also useful, if you don't have a piezo is a long thin diamond bur with irrigation. If you don't have room to place 4.2 implants, you have to regenerate the bone and then place the implants when the site is ready months later. Good luck

I agree, do not use a trephine. A trephine removes to much precious bone that would need to be regenerated. Use a #301 or 701 and extract it like a tooth. This patient probably has a coarse raw vegetable die that over loaded the 8mm implants.

Any of the above mentioned methods will work. If you have access to any of the removal kits (I have the Salvin model) there is a tool that works with reverse threads to engage the center threaded portion of the fixture and back it out. On a side note I have observed with Implant Direct their connection is rather sloppy and sometimes results in fracture at the hex.

I understand that the internal hex is broken/split. However is the enough screw hole/thread apical of the internal hex to allow you to get some purchase using a reverse (counter) screw tool? If you can get enough grip then a simple reversing tool might be all you need to reverse the implant out. If the implant is split to a third down the length, then it may not require much force to unwind the implant. You might also try slotting around the implant and seeing if you can grasp it well enough with small universal forceps to reverse screw it out. Obviously it is hard to be definite but I always think it is worth trying the easiest method first and progressing to more aggressive methods if at first you do not succeed.

hi I just removed a split Hiossen implant, Purchased the Salvin removal kit , worked like a dream (#implant-rescue-kit) page 29 2018 catalogue. backed out the implant without having to raise a flap, than did a socket graft .

I am sorry to "disappoint" you, but implants with a fractured hex can be saved. In several dozens of cases, we have used the SOS system by the Israeli startup "ABraCadabra Implants" to remove the fractured hex, create a new flat platform and restore it anew with telescopic abutments. In the case linked here, we have saved two fractured distal implants under a dolder bar, and restored them with SOS + ChairSide2 telescopic abutments, while the mesial were restored with ChairSide1 telescopic abutments to produce parallelism and proper distribution of occlusal forces, and to prevent further fractures. Thus we could also let go of the dolder bar, as the telescopic abutments provide excellent retention for the overdenture. See panoramic x-rays before and after here: https://www.dropbox.com/s/d0ljekjwxhdb310/sos-before-after.jpg?dl=0

I used a fiber post with Core Tec (Benco brand core material) and prepared a margin on the coronal neck of the implant for some ferrule effect. Material of choice would work fine. As far as cement I used a resin cement but I am sure RMGI would be fine as well. Basically I treated it as an endodontically treated tooth. I will try to gather up some images to post.

As I have said before, half of dentistry is occlusion. I just use a trephine and get in and get out, bone graft and re-implant . If the hex portion is broken and you can't engage a driver then your hands are tied As someone already mentioned, I bet her diet is high in raw veggies and bicuspids are the workhorse with huge lateral forces. I've seen zirconia and cast metal frames break in little old ladies like this. They will surprise you. Many here say they hate to trephine but in a busy practice it makes sense in the bicuspid area. I don't have a hour to fiddle around with some fancy ultrasonic Piezotome, and then end up using a bur anyway.