Nontraumatic Implant Explantation: A Biomechanical and Biological Analysis in Sheep Tibia

Anitua, Eduardo; Murias-Freijo, Alia; Piñas, Laura; Tejero, Ricardo; Prado, Roberto; Orive, Gorka

doi:10.1563/aaid-joi-d-14-00193

Cited by 9 publications

(11 citation statements)

References 26 publications

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“…More recently, other techniques have been proposed based on the application of a reverse torque (Figure 8). 62‐64 The most straightforward approach involves a removal system that matches the implant internal or external connection and sits on top of the implant platform, which must be intact. Removal torque in a counterclockwise direction is exerted with a wrench in a perpendicular position (torque less than 200 N cm; Figure 8).…”

Section: Methods For Removing Dental Implantsmentioning

confidence: 99%

“…In the last 15 years, with the purpose of minimizing surgical invasiveness and to reduce morbidity and t simplify and shorten treatment, procedures based on breaking down the intimate contact between the implant and the bone through the application of shear stress have been advocated. [62][63][64] An example is localized resection via ultrahigh frequency piezosurgical instruments 65 or laser-assisted devices 66 that have demonstrated utility in removing failing dental implants. Nevertheless, these procedures are time consuming, and their invasiveness is debatable.…”

Section: Me Thods For Removing Dental Impl Antsmentioning

confidence: 99%

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Management and sequelae of dental implant removal

Monje

Nart

2022

Periodontology 2000

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Inappropriate and unnecessary implant therapy driven by an erroneous belief that dental implants provide enhanced function and esthetics over diseased or failing teeth has led to a growing burden of implant complications across the globe. Specifically, esthetic and biological complications frequently lead to the unfavorable prognosis of dental implants. Often, these cannot be managed predictably to improve the condition or satisfy patients' demands. In such circumstances, implant removal needs to be considered. Currently, minimally invasive methods based on reverse torque engineering are key to preserve peri‐implant soft and hard tissues. Implant replacement is now feasible, as evidenced by the high survival rates of implants placed at previously failed sites. Notwithstanding these data, clinicians should still consider carefully the expendability of an implant and whether its replacement will satisfy the prosthetic, biomechanical, and esthetic demands of the patient. In the scenario where future implant placement is desired, protocols undertaken for soft/hard tissue grafting and implant placement should be based upon defect morphology and soft and hard‐tissue characteristics. Currently, however, a lack of knowledge of the biological events and dimensional changes that arise following implant removal renders decision‐making complex and challenging, and recommendations remain largely based upon empirical speculation. This chapter will review the indications for implant replacement for prosthetic, biomechanical, and esthetic complications, alongside considerations in decision‐making, planning, implementation, and outcomes of implant replacement.

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Section: Methods For Removing Dental Implantsmentioning

confidence: 99%

Section: Me Thods For Removing Dental Impl Antsmentioning

confidence: 99%

Management and sequelae of dental implant removal

Monje

Nart

2022

Periodontology 2000

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“…The pertinent literature on this subject is practically non-existent, as orthodontics is presumably the only discipline where intact implant removal is seen as a treatment success. Few investigations exist for prosthodontic implant removal [1,6,16,19] or miniscrew removal (e.g. [2,3,11,18,20]).…”

Section: Discussionmentioning

confidence: 99%

“…To the best of our knowledge, only one prospective study on prosthetic implant removal has been published. Explanation reasons were periimplantitis, fracture, or malpositioning [1]. Explantation was performed by application of counter-clockwise torque using a dedicated extraction kit (BTI Biotechnology Institute, Vitoria, Spain) to break the implant-bone union.…”

Section: Discussionmentioning

confidence: 99%

Factors influencing the removal torque of palatal implant used for orthodontic anchorage

2021

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Background A non-invasive method has recently been introduced to remove osseo-integrated palatal implants by using the implantation ratchet which is designed to screw in or unscrew the implants. Although a proof of concept has been published, the torque involved to successfully explant have not been investigated so far. The aim of this study was to assess the removal torque required to explant osseo-integrated and orthodontically utilized palatal implants, and to identify potentially influencing variables. Materials and method Thirty-one consecutive patients (15 females, 16 males; mean age 24.1 ±7.4 years) with fully osseo-integrated and previously orthodontically loaded palatal implants (Orthosystem®: diameter 4.1mm/length 4.2mm/sandblasted with large grits (SLA) surface) were randomly assigned to either clockwise or counter-clockwise non-invasive explantation. The respective explantation tool with an electric torque control was placed on the abutment connection of the implant and secured by an occlusal screw. The primary outcome studied was maximal removal torque (MRT) needed to detach the implant from its socket which was recorded individually together with other potentially influencing secondary outcomes (gender, age, orthodontic loading time, use of local anaesthetics). Student’s t-test was used to contrast MRT difference for the gender, type of suprastructure, use of local anaesthetics, and rotational direction. Spearman correlations was used to investigate associations between MRT and patient’s age or duration loading time. Results Average MRT (148.6 ± 63.2N/cm) using ratchet as a non-invasive removal method of palatal implant was considered safe. The triangular head fractured of palatal implant at a torque level of 300.1 Ncm. Significantly higher explantation were recorded for male patients compared to female patients (182.0 ± 63.0 Ncm vs 112.8 ± 40.8 Ncm; P=0.001). On the other side, the mean removal torque for palatal removal in clockwise direction was non-significantly different (158.3 ± 58.6 Ncm) compared to counter-clockwise direction (139.4 ± 67.9 Ncm). Neither patient’s age (p=0.324) nor loading time (p=0.214) were significantly correlated with removal torque values. Conclusions Pertinent literature on this subject is practically non-existent, as orthodontics is presumably the only discipline where implant removal represents a treatment success. Mean MRT for successful palatal implant removal was 148.6±63.2Ncm, but a large spectrum was observed (minimum 31.5Ncm, maximum 272.8Ncm). This obvious heterogeneity underlines the importance to investigate possible influencing factors. The safe and simple non-invasive method for palatal implant removal necessitates moderate, but not high torque MRTs, independently of the torque direction. The necessary MRT seems clearly influenced by gender, but less so by patient’s age or loading time.

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“…In the last decades, implant dentistry has achieved high success rates as the choice to replace lost dentition of patients being treated with implant-supported prosthesis. 17 Despite high success rates, there are still implants that may be lost due to severe marginal peri-implantitis or IPL. Therefore, different techniques including dental implant removal and implant resection have been proposed in the literature.…”

Section: Discussionmentioning

confidence: 99%

An alternative treatment for hopeless implants: Coronal resection

Kutlu

Goyushov

Tözüm

2020

Journal of Oral Biology and Craniofacial Research

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Dental implant surgery is a highly reliable therapy with widespread use all over the world. However, various accidental symptoms and complications such as peri-implantitis have been reported, and occasionally necessitate implant removal. This alternative technique was performed to minimize the harmful effect of conventional resective explantation procedures. The present case concerns a 55-year-old woman who had two dental implants in the mandibular incisor regions who apparently developed severe marginal peri-implantitis. Presence of lesion was confirmed by two and three-dimensional radiographic images. Explantation was indicated because of the excessive ongoing bone loss around implants. Due to avoid serious complications such as jaw fracture, coronal resection technique (partial explantation) was suggested. After the full thickness flap was elevated, affected part of both implants were resected, and osseointegrated healthy apical parts were left in the basal bone. Wound healing was uneventful at one week follow-up. Proper locater abutments were tightened after 5 months of the partial explantation procedure, and final denture was applied in the oral cavity. The radiologic and clinical examinations showed successful outcome at 12-months follow-up. Minimally resective peri-implantitis therapy may be achieved using this non-traumatic coronal implant resection approach.

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Nontraumatic Implant Explantation: A Biomechanical and Biological Analysis in Sheep Tibia

Cited by 9 publications

References 26 publications

Management and sequelae of dental implant removal

Management and sequelae of dental implant removal

Factors influencing the removal torque of palatal implant used for orthodontic anchorage

An alternative treatment for hopeless implants: Coronal resection

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