Topic

[Surgery]  How to remove this implant


Hi Faculty Members,

 

I'm posting an x-ray of this implant.  I believe it is a 3.0 one piece biohorizon.  The porcelain chipped off and there was an open contact as well.  My plan was to remove the crown and then take a new impression.  Lo and behold, I realized too late that this implant was one piece.

 

Now my only option is to remove this implant and hopefully place another.  I'm thinking that I will graft this area instead of placing an "immediate" implant.  

 

could anyone please suggest how I can remove this implant?  any suggestions?  Trephine it?  

 

Thank you all.


by Ho-Young Chung at Wed, Mar 11, 2015 1:30 AM

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Ho-Young Chung Replied at Thu, Mar 26, 2015 12:35 AM

there's the photo. "oops!!!" oh s$it I think everyone will agree that this abutment is compromised beyond usability. wish I could step back in time but I'll live and learn. Thanks for all the advice everyone. I kept looking for the screw access then it dawned on me that there is no screw access. Then I looked at the PA one more time and realized too late why there is no screw access.



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Bernard Jin Replied at Wed, Mar 25, 2015 5:14 PM

I agree with everyone who has left a comment thus far. When you say that the abutment is damaged - could you please elaborate? Do you have photographs? My thoughts are to remove the crown from the abutment, then prep the abutment down (as if it were a typical crown prep) and proceed from there. This would likely be the least traumatic I believe. But if the abutment has been compromised beyond usability, then removing the implant is the only logical other option. I would still encourage prepping the abutment - if you can establish good resistance form, retention form - it should still work out well. Would love to see photos of the intraoral condition if possible. :)



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Mark Kwon Replied at Wed, Mar 18, 2015 9:22 PM

Those are hard to remove!!! I did few times. very very tough. I literally had to drill it out. trephine removes too much inter proximally. I had to go the buccal route and do grafting to regrow buccal plate. All i can say is "GOOD LUCK" I would follow HY's method. - mark



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Ho-Young Chung Replied at Wed, Mar 11, 2015 3:49 AM

Dr. Chung and Dr. Yeganegi, thank you for your advice. the abutment portion is damaged and not useable unfortunately. I'll have a discussion with the patient and see what she decides. thank you.



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Jim Yeganegi Replied at Wed, Mar 11, 2015 2:59 AM

Dr.Chung has given you great guidance. This is very challenging indeed due to close proximity to adjacent roots. Trephining this would be very very difficult and likely cause iatrogenic damage to root of #24, as Dr.Chung has suggested. Would be great to see CBCt slices to get a better picture, Are there abnormal probing depths or anything suggesting that the implant has not integrated well or there is a buccal bony defect? If not then One thought would be to prep the crown ie:porcelain down to the metal and treat it like a real tooth and take a regular C&B impression and place a new Zirconia crownclosing up the contacts. This has its challenges as well ie: heating up the implant (use copious irrigation) , as well as where to finish the margin to hide the metal. If the smile line is high and the tooth highly visible then you can just prep slightly subgingival; if not then prep to gingival margin and take an impression for a Zirconia crown. This is a bit of heroics , and put there, but may be less traumatic than trying to remove the implant, in this case. Weigh risk factors and discuss with patient. Show us pics and CBCT if you get a chance and keep us posted. Thanks Jim



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Ho-Young Chung Replied at Wed, Mar 11, 2015 2:05 AM

To clarify, normally you could try to reverse torque out an implant. Unfortunately, a one-piece implant can't be done this way.



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Ho-Young Chung Replied at Wed, Mar 11, 2015 1:50 AM

Hi there, very interesting case. Looks like that open contact contributed to the recurrent decay on the mesial of the 2.6. It's a pity but at this time, you have one of two options. take out the implant and graft and possibly place another at the same time or smooth down whatever amount of the abutment you have left and bury it. I'm assuming your patient will want this "crown" replaced. A CBCT is definitely be a must. Please post one if you have one already taken. This would allow us to evaluate the width of the ridge and also how much success you may have after grafting. Trephining this out would be difficult if not impossible without doing a lot of damage. Most trephines have an internal diameter of 3.5 or greater. It does look like an old one-piece Biohorizon. If you drove the trephine apically soon you will hit the mesial of the 2.4. I think the safest way to take out this implant is to take an oral surgery hand piece, remove the buccal plate and elevate the implant out. At the same time horizontal ridge augmentation will be required. Should be very interesting. Good luck. Ho-Young