Plasma rich in growth factors could be a useful tool to enhance the healing of extraction sockets by minimizing postoperative complications and stimulating the hard and soft tissues regeneration.

This study was performed to study the effect of implant surface treatment on the cause and removal torque of failed nonmobile implants. Implant explantation was achieved by the application of countertorque at the implant-bone interface. The explantation socket was examined carefully and curetted to remove any granulation tissue. Immediate implant placement was accomplished when primary stability could be achieved. Eighty-one patients were treated according to the described treatment protocol for the explantation of 158 nonmobile implants in the maxilla and the mandible. The patient's mean age was 62 ± 11 years. The main cause of implant explantation was peri-implantitis (131 implants; 82.9%) followed by malpositioning of the implants (22 implants; 13.9%). The explantation of 139 implants at 146 ± 5 Ncm was performed without the need for trephine bur. However, the use of trephine burs to cut into the first 3 to 4 mm was necessary in 19 explantations, and the removal torque was 161 ± 13 Ncm. All titanium plasma-sprayed implants were removed due to peri-implantitis at a significantly lower torque when compared to acid-etched, particle-blasted, and oxidized implants. The postoperative recovery of the patients was uneventful and the conservation of the available hard and soft tissues was successfully achieved. The protocol followed in this study could constitute a real alternative to other traumatic technique for the removal of failed implants and advanced stages of peri-implantitis. The type of implant surface treatment could influence the value of removal torque and the occurrence of peri-implantitis.

In dental traumatology, the loss of teeth and the supporting alveolar bone in children compromise the proper development of maxillofacial structures and also limit the solutions that can be offered. In this case report, multidisciplinary management is described of a child with a significant loss of alveolar bone and associated teeth due to a traffic accident at 8 years of age. The management involved staged teeth autotransplantation into surgically prepared sites with bone expanders, orthodontic treatment and dental implants. The 3D regeneration of the alveolar process was successfully stimulated by teeth autotransplantation. At the 4-year follow-up visit, evaluation of the autotransplanted teeth and the implants indicated a successful outcome for the patient.

Autologous bone block grafting is an efficient technique to thicken an atrophied residual alveolar ridge. A variable degree of resorption, however, occurs due to graft remodeling. In this study, we hypothesize that under-preparation of implant socket would permit the dental implant to act as a bone expansor and thus compensate for the contraction in the augmented ridge width. For that reason, 10 patients received an autologous bone block graft that was obtained from the ramus of the mandible. Residual alveolar ridge width was measured on CBCT scans obtained before surgery (T0), after 2 months of healing (T1), after 4 months of healing just before implant placement (T2), and after 4 months of implant placement (T3). The thickness of the alveolar ridge was initially increased from 2.5 ± 1.4 to 6.1 ± 2.0 mm. Before implant insertion, this width was decreased to 5.6 ± 2.1 mm. The last measurement after implant insertion indicated an increase to 7.3 ± 1.8 mm. In comparison to the measurements at T1, a loss of about 0.5 mm of the augmented width occurred. But, this loss was compensated by an increment of 1.2 mm at T3 (after implant insertion) if related to the measurement at T1. Neither gingival dehiscence nor block exposure was observed. Within the limitations of this study, under-preparation of implant socket could make the ridge expansion possible during implant insertion and thus to compensate the remodeling of autologous bone block graft.

Preclinical research in a sheep tibia model has been conducted to evaluate the underlying mechanisms of the nontraumatic implant explantation of failed implants, which allow placing a new one in the bone bed. Twelve dental implants were placed in sheep diaphysis tibia and once osseointegrated they were explanted using a nontraumatic implant explantation approach. Implant osseointegration and explantation were monitored by means of frequency resonance, removal torque, and angle of rotation measurement. The host bone bed and the explanted implant surface were analyzed by conventional microscopy and scanning electron microscope. Results show that osseointegration was broken with an angular displacement of less than 20°. In this situation the implant returns to implant stability quotient values in the same range of their primary stability. Moreover, the explantation technique causes minimal damage to the surrounding bone structure and cellularity. This nontraumatic approach allows the straightforward replacement of failed implants and emerges as a promising strategy to resolve clinically challenging situations.