[Surgery]  Failed #35 Implant

Hello everyone, here is a case that I was about to restore when I found a surprising amount of infection surrounding this implant.  First 2 xrays are from placement surgery, 3rd one is from one year later  History:

1.  #35 was extracted due to caries - severe crowding and tooth blocked lingually.  Extremely difficult extraction, significant bone removal and before my PRF days (April 2013)

2.  Patient healed well and in January 2015, we started Invisalign treatment which was used to solve significant crowding and create an appropriate space for #35.  Invisalign finished in February 2016.  Movement of teeth was significant and yet seemed unremarkable throughout.

3.  Hiossen ETIII 3.5x13 implant placed April 2016 with PRF and cover screw.

4.  Patient reported on November 2016 inflammation in the implant site lasting 24 hours and not returning.

5.  March 2017, fistula noted on the ridge above fixture - Rx antibiotics for 1 week.

6.  April 2017 exposure attempted but abundance of granulation tissue present on distal of implant.  Took Pa and decided implant was not salvageable.  Tried to remove but the implant drivers in my ETIII kit would not fit/engage the implant to attempt reversal.

7.  What parts should I have ready for the next attempt for removal?  Maybe a mini implant driver?  Perhaps a trephine in case of integration?

8.  I have never had to do a trephine yet and thought I would reach out to have your thoughts/advise before attmepting.

9.  Once the implant is out, I will do bone graft with aPRF.

Thank you for looking at this case.


by Anand Choubal at Mon, May 8, 2017 7:54 AM

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Ho-Young Chung Replied at Mon, May 8, 2017 10:05 AM

Hi Anand,

I get a feeling that you tried using an RP driver to remove this 3.5 fixture.  The mini implant driver in HiOssen kit is the 3.5 fixture driver.  Has there been a mesial tilt of tooth 36?  I'm not sure whether there is enough space for a crown with adequate emergence profile for this edentulous space.  Also, before removing this implant, I would suggest checking to make sure that an impression coping will come through the edentulous space so that you know that a replacement implant can be restored.  I have little experience with Invisilign treatment but ideally, the 36 should be distalized (not sure whether Invisilign can do that).  

your 35 implant placement/position is good.  It's the lack of space that is a concern to me.  

You may need fixture removal tool, however, as the fixture can fracture (especially NP platform for any implant company) if you try to reverse torque it using just the fixture driver (depending on how well it is integrated and how much torque you need to apply).  When using fixture driver only to remove an integrated implant, the fixture can either flower or crack depending on the grade of titanium or titanium alloy.  fixture removal tools have a core screw that engages the internal structure then a removal tool can be used to "wrap" around the external walls of the implant to reverse torque the fixture without "popping" the fixture from the inside.  

However, sometimes you have to resort to more "traumatic" methods in order to remove a fixture.  fixture removal tool is the ideal choice but sometimes you have to sacrifice the buccal plate in order to remove an implant.  

Ho-Young Chung